Customized reconstruction of an extensive mandibular defect : a clinical report

Abstract

Myoepithelial carcinomas are rare malignant tumors arising from salivary glands. They most commonly involve the parotid and minor salivary glands but may also occur in the submandibular glands. These tumors can become extensive, causing bony expansion and destruction. A 31-year-old man with a large swelling on the left side of the face is presented. Histologic examination of an incisional biopsy confirmed a diagnosis of a myoepithelial carcinoma arising from the left submandibular salivary gland. After tumor resection, the patient's mandible was reconstructed with a customized mandibular framework produced by means of 3-dimensional (3D) laser sintering. This approach significantly reduced cost, advanced surgical procedures, and operating room time, which is of great benefit in a developing country like South Africa.

The reconstruction of mandibular defects after resective surgery has always been challenging for surgeons. Several factors need to be considered in the planning of these reconstructions, including the anatomic diversity of the region and the complexity of mandibular movements. Mandibular movements coordinate basic oral functions, including mastication, deglutition, phonetics, and facial muscle tone maintenance. These are important for maintaining life and for social inclusion.

Gold standards of treatment for reconstructing segmental defects after resective surgery include advanced microsurgery with fibula-free flaps with costochondral rib and iliac bone grafts. These surgeries are rarely possible in developing countries like South Africa because of high costs and shortages of intensive care unit facilities, operating room equipment, and vascular surgeons. Digital reconstruction with 3-dimensional (3D) laser sintering allows the fabrication of an exact titanium replica of the segment to be resected, as a viable treatment alternative.