Rigid fixation in mandibular reconstruction

A primary goal of mandibular reconstruction is to preserve form and function. Free vascularized bone remains the gold standard for mandibular reconstruction of the anterior defect. While lateral mandibular defects need for vascularized bone remain controversial, free bone flaps provide the most reliable bone stock readily available for dental implantation. Mandibular alignment remains critical for recreating the 3-dimensional relationships of mandibular projection, occlusion, and condylar placement. Depending on the defect, a variety of techniques can be used to maintain mandibular alignment. These include prefabrication of the plate, placement of an internal fixation device, and intermaxillary fixation. Fixation techniques in this day and age generally rely on plates and screws. Miniplates are popular among some reconstructive surgeons while others prefer larger reconstruction plates that can span the entire defect. Bony contouring is critical since keeping bone surfaces in contact allows for improved bone healing. Condylar reconstruction this critical, when the ramus and condylar head are resected, require reconstruction to maintain the entire solid arch. A variety of these techniques are discussed. While the challenge remains reconstituting a solid arch, a variety of techniques can be employed. These techniques including fixation technique, bony contour, mandibular alignment, and condylar reconstruction will be discussed.