Functional mandibular reconstruction: prevention of the oral invalid

Composite mandibulectomy for carcinoma can create an "oral invalid," with difficulty in mastication. Functional reconstruction has fallen short of ideal. Three patients were seen with significant anatomic deficits and functional debilitations resulting from large composite mandibulectomies for oral carcinoma. Each patient underwent reestablishment of the mandibular arch with a vascularized iliac crest bone graft. Following complete healing, the dental arch was replaced with a fixed prosthesis by the technique of osseointegration. The creation of a fixed osseodental unit has allowed each of these individuals to return to a state of anatomic, functional, psychological, and social good health. Follow-up has been from 6 months to 2 years.