Reconstruction of the horizontal rami of the mandible following avulsion in childhood.
A 7-year-old boy was involved in a road traffic accident in October 1971, and apparently had been dragged along face downwards with resultant avulsion of the entire horizontal mandibular rami, and most of the mandibular alveolar soft tissue and teeth. Repair by metal implants was attempted but these proved unsatisfactory, and soft tissue replacement for the missing alveolus was carried out by flap raised from arm. Rib grafting was carried out on three occasions at almost yearly intervals, but each time, probably owing to vascular insufficiency, non-union (or more correctly non-replacement) occurred in the left canine region. To "import" a new blood supply, and free some of the scar tissue, a compound muscle/bone/skin flap bearing the clavicle and sternomastoid muscle was transposed to the mandibular bed. This form of grafting was used extensively in World War I to repair facial gunshot wounds, and the transposed blood supply enabled success in the pre-antibiotic period. Bony union is now satisfactory 5 years after injuries and dentures have been recently fitted; speech is normal, the child's facial contours acceptable, and mastication has been satisfactory during this period.
D016025:Bone Transplantation; D002648:Child; D003817:Dentition; D005151:Facial Injuries / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008337:Mandibular Fractures / Q000601:surgery; D008338:Mandibular Injuries / Q000601:surgery*; D008409:Mastication; D008722:Methods; D009132:Muscles / Q000637:transplantation; D012272:Ribs / Q000601:surgery; D016038:Skin Transplantation; D013060:Speech; D014182:Transplantation, Autologous