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MANAGEMENT OF MANDIBLE.pptx
- 1. MANAGEMENT OF MANDIBLE PRESENTED BY:DR MONALISA BANERJEE GUIDE:DR RAJESH A KANTHARIA
- 4. NEED FOR THIS DISCUSSION • OCCLUSION • SPEECH • SWALLOWING • MASTICATION • ORAL COMPETENCE • TONGUE FALL • APPEARANCE • TONGUE MOBILITY
- 5. Preferable point of entry-point of abutment ie. Junction of the attached and reflected mucosa-Dentulous mandible Occlusal surface: Edentulous mandible.
- 6. Other points of entry • From the oral cavity through the upper surface of the mandible (occlusal route) • Through the mental foramen • Secondary tumors in the neck through the lower border • The mandibular foramen • Cortical bone defects in the edentulous ridge • Periodontal membrane in the dentate mandible • The attached gingiva.
- 7. MANDIBULAR RESSECTION • MUCOPERIOSTEAL STRIPPING • MARGINAL MANDIBULECTOMY • SEGMENTAL MANDIBULECTOMY
- 8. MUCOPERIOSTEAL STRIPPING INDICATIONS • No bony erosion • Tumor close to the mandible but adequate margins available without bone erosion(0.5 cm) CONTRAINDICATION • Close margins • Periosteal involvement • Received RT • Edentulous mandible
- 10. MARGINAL MANDIBULECTOMY INDICATIONS • Superficial bony erosion. • Tumor close to the mandible to achieve adequate margins • Minimal periosteal involvement CONTRAINDICATIONS • Post radiotherapy • Edentulous mandible • Gross bony erosion • Gross periosteal involvement/paramandibular disease
- 11. CONSERVATIVE MANDIBULAR RESSECTION TYPES • Rim resections-horizontal/vertical • Lingual plate resection • Buccal plate resection • Oblique marginal resection • Reverse marginal resection
- 14. LINGUAL PLATE EXCISION Done in FOM diseases. Technically difficult.
- 19. PRECAUTIONS
- 20. SEGMENTAL MANDIBULECTOMY • Indications • Gross bony erosion • Post RT • Edentulous mandible • Gross periosteal involvement/paramandibular disease • Whenever inferior bony margin of 1 cm is not possible
- 21. SEGMENTAL RESSECTION TYPES • POSTERIOR • LATERAL • ARCH PRESERVING HEMIMANDIBULECTOMY • HEMIMANDIBULECTOMY • ANTERIOR SEGMENTAL RESECTION • EXTENDED HEMIMANDIBULECTOMY
- 22. DEFECT CLASSIFICATIONS • JEWER,BOYD(HCL) • URKEN(CRBS) • SCHULTZ • BROWNS
- 23. JEWER AND BOYD(1989) Published first in 1989. Uses 3 uppercase alphabets(H,C,L) to classify bony defects H(Hemi-mandibulectomy)stands for lateral segmental defects of any length including condyle. C-Central defects(canine to canine) L-Lateral defects excluding condyle. Total 8 classes of bony defects possible- H,L,C,HC,LC,LCL,HCL,HCH
- 24. BOYD’S MODIFIED CLASSIFICATION • INCLUDED THE SOFT TISSUE DEFECTS • Added 3 lower case alphabets(o,m,s) • o- no mucosal or skin component • m-mucosal component • S-skin component
- 25. URKEN ET AL • CRBS CLASSIFICATION
- 26. SCHULTZ ET AL
- 28. RESULTS Sixty-eight patients were enrolled over 3 years and randomly assigned to either SA (34 patients) or IA (34 patients). The median follow-up was 3.6 years. Mandibular preservation was achieved in 16 of 34 patients in the IA. The disease-free survival and overall survival were similar in both the arms. Complications were similar in both arms, but chemotherapy-induced toxicity was observed in the majority of patients