Current concepts in mandibular reconstruction by microsurgical free flaps.
Restoration of form and function after composite oro mandibular resections, especially those of the symphysis, is one of the greatest challenges facing the reconstructive surgeon. Loss of the anterior mandibular arch results in serious impairment of oral competence, speech, deglutition, and mastication producing th~ striking cosmetic disfigurement characterized by the "Andy Gump" caricature of the 1930s (Fig. l)Y The pathomechanics of this deformity are due to anterior and medial deviation of the lateral mandibular segments by the residual mylohyoid muscles and superior displacement by the medial pterygoid, masseter, and temporalis muscles. In comparison, these deforming forces are relatively absent following lateral mandibulectomy. Prevention of the "Andy Gump" deformity and its sequelae is paramount and often mandates composite replacement of bone, skin and mucosa. Additionally, through-and-through lateral or posterior defects requiring trilaminar replacement of skin, bone and mucosa or long bone gaps crossing the midline with massive soft tissue losses pose formidable reconstructive challenges.
Weinzweig
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Division of Plastic Surgery, Department of Orthopedic Surgery, University of Illinois at Chicago and Cook County Hospital, Chicago, IL, USA.
Weinzweig
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