tumors of the mandible part 3: surgical decision making

7/25/2019 Tumors of the Mandible Part 3: Surgical Decision Making

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TUMORS OF THE MANDIBLE

PART III: SURGICAL DECISION-MAKING

REYNALDO O. JOSON, M.D.


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TABLE OF CONTENTS

Introd!t"on ......................... #O$%&!t"'&( ........................... #

R&!o))&nd&d Pr&*+r+t"on .............. I. D"+no("(

A. R+d"oo"! D"+no("(......... / B. B"o*(0 ...................... 1

II. Tr&+t)&nt

A. Ind"!+t"on( 2or Non-o*&r+t"'&

Tr&+t)&nt ................... 3 B. Ind"!+t"on( 2or O*&r+t"'&

Tr&+t)&nt ................... 3III. E4t"r*+t"on

A. T0*&( ....................... 5

B. S&&!t"on ................... 5

C. Intr+or+ or E4tr+or+A**ro+!6 .................... 7

I8. R&!on(tr!t"on A. Ind"!+t"on( ................. 7

B. R&!on(tr!t"'& Pro!&dr&( ... 9 C. Pro$&)( .................... #

D. S&&!t"on ................... #

E. At6or;( Pr&2&r&n!& ......... ##

F. Contr+"nd"!+t"on( ........... # G. D&nt+ Pro(t6&("( ........... #/

8. Co)*"!+t"on( o2 M+nd"$+rSr&r0 ........................ #/

8I. In(tr)&nt( +nd E


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INTRODUCTION

T6"( "( t6& t6"rd o2 + (&r"&( o2*ror+)( on )+nd"$+r t)or(. T6& 2"r(t

*ror+) *r&(&nt( &n&r+"t"&( +nd *r"n!"-*&( "n t6& d"+no("( +nd tr&+t)&nt o2

)+nd"$+r t)or(. T6& (&!ond *ror+)*r&(&nt( "(tr+t"'& !+(&(.

T6"( *ror+) "( d&("n&d to 6&* t6&

(r&on( "n t6&"r d&!"("on-)+>"n =6&n!on2ront&d ="t6 *+t"&nt( ="t6 )+nd"$+r

t)or(. T6& d&!"("on-)+>"n =" "n'o'&$ot6 d"+no("( +nd tr&+t)&nt.

OBJECTI8ES

At t6& &nd o2 t6& *ror+), t6& (&r

"( &4*&!t&d to $& +$& to:

#. D"+no(& *ro*&r0 *+t"&nt( ="t6

)+nd"$+r t)or.

. Ind"!+t& ("t+t"on( =6&r& + $"o*(0"( n&&d&d.

/. Id&nt"20 *+t"&nt( ="t6 )+nd"$+rt)or( =6o do not n&&d o*&r+t"'&

tr&+t)&nt.

1. Id&nt"20 *+t"&nt( ="t6 )+nd"$+r

t)or( =6o n&&d o*&r+t"'& tr&+t- )&nt.

3. S&&!t t6& *ro*&r &4t"r*+t"'& *ro- !&dr& 2or *+t"&nt( ="t6 )+nd"$-

+r t)or( n&&d"n o*&r+t"on(. 5. S&&!t t6& *ro*&r r&!on(tr!t"'&

*ro!&dr& 2or *+t"&nt( ="t6 )+nd"-

$+r t)or( n&&d"n o*&r+t"on(.

?. For)+t& + *r&o*&r+t"'& *+n 2or*+t"&nt( ="t6 )+nd"$+r t)or(

=6o n&&d +n o*&r+t"on.

#


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7. For)+t& +n "ntr+o*&r+t"'& *+n

2or *+t"&nt( =6o +r& to nd&ro

)+nd"$+r (r&r0. 9. For)+t& + *o(to*&r+t"'& *+n

2or *+t"&nt( ="t6 )+nd"$+rt)or( =6o 6+'& nd&ron& + (&-

)&nt+ )+nd"$&!to)0 +nd r&!on- (tr!t"on.

RECOMMENDED PREPARATION

B&2or& o"n t6ro6 t6"( *ror+),

t6& (&r (6od 6+'& (+t"(2+!tor"0

!o)*&t&d t6& 2"r(t t=o *ror+)( "n t6&

(&r"&(, n+)&0:

Jo(on, RO : T)or( o2 t6& M+nd"$&: G&n&r+"t"&( +nd Pr"n!"*&(.

M+n"+, #99.

Jo(on, RO : T)or( o2 t6& M+nd"$&:

I(tr+t"'& C+(&(.

M+n"+, #99.


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I. DIAGNOSIS

A. RADIOLOGIC DIAGNOSIS

T6& !"n"!+ d"+no("( o2 + )+nd"$-+r t)or r&"&( 6&+'"0 on t6& r+d"or+-

*6"! 2"nd"n(. P60("!+ &4+)"n+t"on, )or&o2t&n, on0 &+d( t6& *60("!"+n to ((*&!t

t6& *r&(&n!& o2 + )+nd"$+r t)or. It "(

d"22"!t to (*&!"20 t6& t0*& o2 )+nd"$-

+r t)or %(t $+(&d on *60("!+ &4+)"n+-t"on.

R+d"or+*60 !+n !on2"r) or d"(*ro'&

t6& *r&(&n!& o2 + )+nd"$+r t)or

((*&!t&d dr"n t6& *60("!+ &4+)"n+t"on.

B+(&d on r+d"or+*6"! 2"nd"n(, t6&*60("!"+n !+n ((*&!t t6& t0*& o2

)+nd"$+r t)or t6+t )+0 $& *r&(&nt.At6o6 t6& r+d"oo"! d"+no("( "( on0

+ ((*&!t =6"!6 6+( to $& !on2"r)&d ord"(*ro'&d $0 + )"!ro(!o*"! &4+)"n+t"on, "t

!+n +r&+d0 6&* t6& (r&on "n 6"(

d&!"("on-)+>"n on tr&+t)&nt.

I2 t6& r+d"or+*60 !+nnot *rod!& +

(*&!"2"! d"+no("( o2 t6& )+nd"$+rt)or, "t !+n (t" *ro'"d& ot6&r '++$&

"n2or)+t"on to t6& (r&on. S!6 "n2or)+-

t"on !+n !o)& "n t6& 2or) o2 =6&t6&r t6&

t)or:

#. I( + (r"!+ or non(r"!+d"(&+(&@

. I( $&n"n or )+"n+nt@ or /. In'o'&( t6& 2-t6"!>n&(( o2

t6& )+nd"$& or not.

/


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B. BIOPSY

A (&!t"on $"o*(0 "( "nd"!+t&d =6&n +d&2"n"t"'& d"+no("( "( n&&d&d $&2or& +

d&!"("on on t6& tr&+t)&nt !+n $& )+d&.T6"( "( (+0 (&&n "n ("t+t"on( =6&r&"n

no d&2"n"t"'& d"+no("( !+n $& )+d& +( to=6&t6&r t6& )+nd"$+r t)or "( + (r"!+

d"(&+(& or not.

M"!ro(!o*"! &4+)"n+t"on o2 + )+nd"$-+r t)or "( (+0 *r&!&d&d $0 + d&!+-

!"2"!+t"on o2 t6& $on& +nd t6"( &nt+"( +("n"2"!+nt +)ont o2 t")&, !o))on0 "n

t&r)( o2 d+0(. For t6"( r&+(on, + 2ro&n

(&!t"on (td0 o2 + )+nd"$+r t)or "(

not *o(("$&. T6(, "2 + d&2"n"t"'&d"+no("( "( n&&d&d $&2or& tr&+t)&nt, t6&n

+ (&!t"on $"o*(0 (6od $& don&.

T6"( >"nd o2 + ("t+t"on "(, 6o=&'&r,r+r&0 (&&n "n !"n"!+ *r+!t"!&,

*r")+r"0 $&!+(& )+nd"$+r t)or( +( +

non(r"!+ d"(&+(& +r& n!o))on. Frt6&r-

)or&, t6& r+d"or+*6"! 2"nd"n( (+0*ro'"d& !& to t6& d"+no("( o2 t6&

)+nd"$+r t)or(.

A (&!t"on $"o*(0 nd&r o!+

+n&(t6&("+ "( +((o!"+t&d ="t6 + ("n"2"-

!+nt *+"n +nd d"22"!t0 $&!+(& "t &n-t+"( r&)o'"n $on&. B&("d&(, "t )+0 (*"

t6& !ont&nt o2 t6& t)or +nd *ro'"d& n"d"2or r&!rr&n!&( t6ro6 !ont+)"n+t"on. For

+ t6&(& r&+(on(, + (&!t"on $"o*(0 "((+0 not *&r2or)&d *r&o*&r+t"'&0. A

*r&o*&r+t"'& d"+no("( +nd d&!"("on-)+>"n

+( to t6& t0*& o2 o*&r+t"'& *ro!&dr& to

*&r2or) r&0 6&+'"0 on t6& r+d"or+*6"!2"nd"n(. E'&n dr"n t6& o*&r+t"on, +

2ro&n-(&!t"on $"o*(0 "( (+0 not don&2or r&+(on( +r&+d0 )&nt"on&d +$o'&.

1


7/30

Intr+o*&r+t"'& &'++t"on o2 t6& t)or on

+ ro(( &'&, 6o=&'&r, "( t""&d +(

)!6 +( *o(("$&, $&2or& +nd r"6t +2t&rt6& r&)o'+ o2 t6& t)or.

II. TREATMENT

Tr&+t)&nt o2 )+nd"$+r t)or( "(

&"t6&r o*&r+t"'& or non-o*&r+t"'&.

M+%or"t0 o2 t6& )+nd"$+r t)or( ="n&&d +n o*&r+t"'& tr&+t)&nt. On0 + 2&=

=" n&&d + non-o*&r+t"'& tr&+t)&nt.

A. SOME INDICATIONS FOR NON-OPERATI8E

TREATMENT

#. M+nd"$+r t)or( (&!ond+r0 to +n

&ndo!r"n& or )&t+$o"! +$nor)+"t0. T6&tr&+t)&nt 6&r& "( d"r&!t&d to=+rd t6&

nd&r0"n &ndo!r"n& or )&t+$o"!+$nor)+"t0.

E4+)*&: 60*&r*+r+t60ro"d"() ="t6

)+nd"$+r &("on(.

. B&n"n t)or( =6"!6 !+n $& &2t+on& +nd )on"tor&d. E4+)*&: ()+ o(t&o-

)+(. /. M+"n+nt t)or( =6"!6 +r& not r&-

(&!t+$& or not +d'"(+$& to r&(&!t,

&"t6&r *r")+r0 or )&t+(t+t"! !+n!&r.

B. SOME INDICATIONS FOR OPERATI8ETREATMENT

#. D"+no("( o2 + (r"!+ )+nd"$-

+r t)or d"(&+(&.

. A )+nd"$+r t)or ="t6 !o)*"!+-

t"on( t6+t +r& $&(t r&)&d"&d $0 +no*&r+t"on. E4+)*&( o2 !o)*"!+t"on( +r&

*+"n, 2+!"+ d&2or)"t0, +nd )+(t"!+tor0d0(2n!t"on.

3


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III. ETIRPATION

A. TYPES OF ETIRPATI8E PROCEDURES

T6& t0*&( o2 &4t"r*+t"'& *ro!&dr&(t6+t +r& (+0 don& on )+nd"$+r t)or(

+r& t6& 2oo="n: #. Cr&tt+&

. E4!"("on

/. M+r"n+ )+nd"$&!to)0

1. S&)&nt+ )+nd"$&!to)0

Cr&tt+& +nd &4!"("on +r& !on(&r'+-t"'& *ro!&dr&( =6"!6 +r& (+0 don& on

$&n"n t)or(. On t6& ot6&r 6+nd, )+r"n+

+nd (&)&nt+ )+nd"$&!to)0 +r& ="d&

&4!"("on+, t6&r&2or&, )or& r+d"!+ *ro!&-dr&(. T6&(& +r& (+0 don& on )+"n+nt

t)or( +nd $&n"n t)or( =6"!6 +r& noto-r"o( 2or r&!rr&n!& +2t&r + !on(&r'+t"'&

*ro!&dr&.

S&)&nt+ )+nd"$&!to)0 !+n "n'o'&

+n0 *+rt or (&)&nt o2 t6& )+nd"$&. It

!+n $& &(( t6+n + 6&)")+nd"$&!to)0.A o2 t6&(& d"22&r&nt &4t&nt( o2

)+nd"$&!to)0 +r& +(o !+&d ($tot+)+nd"$&!to)0.

A tot+ )+nd"$&!to)0 "( t&!6n"!+0

2&+("$&. Ho=&'&r, "n !"n"!+ *r+!t"!&,t6&r& "( r+r&0 +n o!!+("on 2or "t to $&

don&.

B. SELECTION OF ETIRPATI8E PROCEDURE

T6& t0*& o2 &4t"r*+t"'& *ro!&dr& to

*&r2or) on + *+rt"!+r )+nd"$+r t)or"( d&*&nd&nt )+"n0 on t6& d"+no("( +nd

&4t&nt o2 t6& t)or, =6"!6 +r& (+0d&r"'&d 2ro) + r+d"or+*6"! (td0.

5


9/30

A( to t6& d"+no("(, t6& )or&

")*ort+nt !on("d&r+t"on( "n t6& d&!"("on-)+>"n +r&:

#. I( "t $&n"n or "( "t )+"n+nt A)+"n+nt &("on =" &nt+" + )or&

r+d"!+ &4t"r*+t"'& *ro!&dr&, =6&r&+(, +$&n"n &("on, + )or& !on(&r'+t"'& or &((

r+d"!+ *ro!&dr&.

. I2 "t "( $&n"n, =6+t "( "t +nd

=6+t "( t6& $&(t tr&+t)&nt 2or (!6 +t)or $+(&d on *+(t &4*&r"&n!& C+n "t $&

!r&tt&d +nd &4!"(&d ="t6ot "n!rr"n +6"6 "n!"d&n!& o2 r&!rr&n!& Or (6od "t

$& ="d&0 &4!"(&d to +'o"d + r&!rr&n!&

A( to t6& &4t&nt o2 t6& t)or, t6&n&((o2 t6& )+nd"$& t6+t + (&)&nt+

)+nd"$&!to)0 6+( to $& don& . I2 "t do&( not, "( "t *o(("$& to

do + )+r"n+ )+nd"$&!to)0 or

+n0 ot6&r *ro!&dr& t6+t do&( not

d&(tro0 t6& !ont"n"t0 o2 t6& $on&.

B&o= "( + t+$+t"on o2 t6& )or&!o))on )+nd"$+r t)or( +nd t6&"r (+

r&!o))&nd&d &4t"r*+t"'& tr&+t)&nt.

T)or( Tr&+t)&nt

O(t&o)0&"t"( Cr&tt+&R+d"!+r !0(t E4!"("on

D&nt"&ro( !0(t E4!"("onA)&o$+(to)+ S&)&nt+

)+nd"$&!to)0

M+nd"$+r !+n!&r S&)&nt+

)+nd"$&!to)0G"n"'o-+'&o+r M+r"n+

!+n!&r )+nd"$&!to)0

?


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C. INTRAORAL OR ETRAORAL APPROACH

T6& +**ro+!6 to (&, =6&t6&r

"ntr+or+ or &4tr+or+, =" d&*&nd*r")+r"0 on t6& &+(& ="t6 =6"!6 t6&

!ont&)*+t&d o*&r+t"'& *ro!&dr& $ot6&4t"r*+t"'& +nd r&!on(tr!-t"'& !+n $&

*ro*&r0 don&. A (&!ond 2+!tor "( t6&

"nt&nt"on to +'o"d +n &4t&rn+ (!+r on t6&

n&!>.

In &n&r+, 6o=&'&r, + !r&tt+&, +n&4!"("on, +nd + )+r"n+ )+nd"$&!to)0

!+n $& don& t6ro6 t6& "ntr+or+

+**ro+!6. A (&)&nt+ )+nd"$&!to)0 +nd +

r&!on(tr!t"'& *ro!&dr& o2 + )+nd"$+rd&2&!t +r& (+0 don& t6ro6 +n

&4tr+or+ +**ro+!6.

I8. RECONSTRUCTION

A. INDICATIONS

A $r&+> "n t6& !ont"n"t0 o2 t6&

)+nd"$& =6"!6 r&(t( "n 2+!"+ d&2or)"t0

+nd )+(t"!+tor0 d0(2n!t"on "( +n

"nd"!+t"on 2or )+nd"$+r r&!on(tr!t"on.S!6 + !ond"t"on "( (&&n +2t&r + (&)&nt+

)+nd"$&!to)0 "n =6"!6&'&r o!+t"on "nt6& )+nd"$& "t "( *&r2or)&d. T6& 2+!"+

d&2or)"t0 "(, 6o=&'&r, )or& *ronon!&d "n+ (&)&nt+ )+nd"$&!to)0 "n'o'"n t6&

)&nt) +( !o)*+r&d to t6+t "n'o'"n t6&

$od0 o2 t6& )+nd"$&.

7


11/30

T6(, =6&n&'&r + (&)&nt+ )+nd"$-

&!to)0 "( to $& *&r2or)&d, + r&!on(tr!-

t"'& *ro!&dr& )(t $& !on("d&r&d "n t6&*r&o*&r+t"'& *+nn"n. In 2+!t, + r&!on(-

tr!t"on )(t $& *&r2or)&d n&(( t6&r&+r& !ontr+"nd"!+t"on( or t6&r& +r& '+"d

r&+(on( not to do (o.

B. RECONSTRUCTI8E PROCEDURES

A $r&+> "n t6& !ont"n"t0 o2 t6&

)+nd"$& !+n $& r&!on(tr!t&d ("n &"t6&r+ $on& r+2t, + *ro(t6&("(, or +

!o)$"n+t"on o2 $ot6.

A $on& r+2t )+0 $& +n +tor+2t,)&+n"n !o)"n 2ro) t6& *+t"&nt 6")(&2,

or +n +or+2t, !o)"n 2ro) +not6&r*&r(on. A $on& +tor+2t )+0 $& + 2r&&

r+2t, + *&d"!&d )0o-o((&o( r+2t, or +r+2t ="t6 )"!ro'+(!+r r&!on(tr!t"on.

T6& !o))on (or!&( o2 $on& r+2t +r& t6&

r"$(, t6& ""+! $on&(, +nd t6& !+'"!&(.

A *ro(t6&("( !+n !o)& "n t6& 2or) o2

+ K"r(!6n&r ="r&, + )&t+"! *+t&, or +)&t+"! or *+(t"! tr+0. A )&t+"! *+t&

!+n $& + (t+"n&(( (t&&, t"t+n"), or

'"t+"). T6& tr+0 !+n $& + )&t+ or

*+(t"! )+t&r"+ d+!ron or *o0r&t6+n&"n =6"!6 $on& !6"*( +r& *+!&d.

E4+)*&( o2 + !o)$"n&d )&t6od +r&

t6& (& o2 )&t+"! or *+(t"! tr+0( ="t6$on& !6"*(, + )&t+"! *+t& ="t6 + 2r&&

$on& r+2t, +nd + K"r(!6n&r ="r& "n(&rt&d

t6ro6 + r"$ or 2r+)&nt( o2 $on& r+2t(.

9


12/30

C. PROBLEMS OF RECONSTRUCTI8E PROCEDURES

A )+%or *ro$&) ="t6 *ro(t6&("( "(r&%&!t"on ("n!& "t "( + 2or&"n $od0.

Anot6&r ("n"2"!+nt *ro$&) "( t6& !o(t o2t6& *ro(t6&(&(. T6& !6&+*&(t *ro(t6&("( "(

t6& K"r(!6n&r ="r&.

For +tor+2t(, t6& )+%or *ro$&) "(

$on& r&(or*t"on. It "( 2or t6"( r&+(on

t6+t + *&d"!&d )0o-o((&o( r+2t +nd +r+2t ="t6 )"!ro'+(!+r r&!on(tr!t"on

=&r& t6o6t o2 to o$'"+t& t6& *ro$&) o2r&(or*t"on o2 2r&& $on& r+2t(. T6&

*r&2&r&n!& 2or !+n!&o( o'&r !ort"!+

$on& 6+( +(o ot to do ="t6 $on&

r&(or*t"on. T6& ot6&r ("n"2"!+nt *ro$&)(="t6 +tor+2t +( !o)*+r&d to t6& (& o2

*ro(t6&("( +r& t6& on&r o*&r+t"n t")&,t6& *o(to* *+"n +t t6& donor ("t&, +nd

*o(("$& non-n"on o2 t6& $on& r+2t.

For +or+2t(, =6"!6 +r& (+0

$+n>&d $on&, t6& )+%or *ro$&)( +r&

r&%&!t"on, r&(or*t"on, non-n"on, +nd"n+'+"+$""t0.

A !o))on *ro$&) to + )+nd"$+r

r&!on(tr!t"'& *ro!&dr&( "( "n2&!t"on,

*r")+r"0 $&!+(& o2 t6& !ont+)"n+t&d +r&+

"n =6"!6 t6& *ro!&dr&( +r& $&"n*&r2or)&d, "n t6& or+ !+'"t0.

D. SELECTION OF RECONSTRUCTI8E PROCEDURE

T6& (&&!t"on o2 + *+rt"!+r r&!on(-

tr!t"'& *ro!&dr& "( d&*&nd&nt on + ot

o2 2+!tor(, (o)& o2 =6"!6 +r& &n)&r+t&d$&o=:

#


13/30

#. T6& $++n!"n o2 t6& *ro( +nd !on(

o2 t6& d"22&r&nt r&!on(tr!t"'&

*ro!&dr&(. . T6& +'+"+$""t0 +nd +22ord+$""t0

o2 t6& *ro(t6&(&(./. T6& +'+"+$""t0 o2 *ro*&r "n(tr-

)&nt( +nd &


14/30

&nd(. 6&n "t "( r&)o'&d $&!+(& o2

2+"r&, t6& +((o!"+t&d r&r&t( =" not$& +( )!6 +( t6o(& 2&t =6&n + $on& r+2t

or + )or& &4*&n("'& *ro(t6&("( =+( (&d+nd 2+"&d.

No do$t + )&t+"! *+t& =" o22&r

+ $&tt&r !o()&t"! r&(t t6+n + K"r(!6n&r

="r&. Ho=&'&r, "t "( &4*&n("'& +nd not

+22ord+$& $0 )o(t F""*"no *+t"&nt(. T6&+t6or "( (t" oo>"n 2or + &((

&4*&n("'& )&t+"! *+t&.

F. CONTRAINDICATIONS

"t6 t6& (& o2 K"r(!6n&r ="r& +( +

)&t6od o2 r&!on(tr!t"on, t6&r& "( no (!6+ t6"n +( !ontr+"nd"!+t"on to r&!on(tr!-

t"on +n0)or&.

A(o, "2 t6& r&!on(tr!t"on !+nnot $&

don& r"6t +2t&r t6& &4t"r*+t"on, "t !+n

$& don& +t + 2tr& d+t&. Ho=&'&r, +("))&d"+t& r&!on(tr!t"on "( *r&2&rr&d o'&r

d&+0&d r&!on(tr!t"on. An "))&d"+t&r&!on(tr!t"on )+0 &nd * ="t6 %(t on&

o*&r+t"on. A d&+0&d r&!on(tr!t"on, +t

&+(t t=o o*&r+t"on(. Mor&o'&r, t6&

!o()&t"! r&(t "( (+0 )or& (*&r"or"n "))&d"+t& r&!on(tr!t"on t6+n t6+t

+2t&r + d&+0&d r&!on(tr!t"on. In t6&+tt&r, 2"$ro("( +nd !ontr+!tr& 6+'&

+r&+d0 (&t "n.

#


15/30

G. DENTAL PROSTHESIS

A2t&r + )+nd"$+r d&2&!t r&!on(tr!-t"on, to r&(tor& t6& )+(t"!+tor0 2n!t"on,

+ d&nt+ *ro(t6&("( 6+( to $& 2"tt&d $0 +nort6odont"(t. T6& d&nt+ *ro(t6&("( !+n

+(o 6&* r&(tor& t6& 2+!"+ !ontor. T6&*ro(t6&("( !+n $& 2"tt&d +$ot 2or =&&>(

+2t&r t6& o*&r+t"on.

8. COMPLICATIONS OF MANDIBULAR SURGERY

Co)*"!+t"on( )+0 $& d"r&!t0 r&+t&d

to t6& &4t"r*+t"'& *ro!&dr&, to t6&

r&!on(tr!t"'& *ro!&dr&, or to $ot6.So)& o2 t6& )or& !o))on !o)*"!+t"on( o2

)+nd"$+r (r&r0 +r& &n)&r+t&d $&o=:

#. Un"nt&nt"on+ 2r+!tr& o2 t6& )+n- d"$& $ot6 dr"n t6& &4t"r*+t"'&

+nd r&!on(tr!t"'& *ro!&dr&(.

. R&!rr&n!& o2 t6& t)or +( +

r&(t o2 "n+d&


16/30

8I. INSTRUMENTS AND EUIPMENTS

An o*&r+t"on on t6& )+nd"$& r&


17/30

8I. HO I DO IT

A (&)&nt+ )+nd"$&!to)0 2oo=&d$0 + K"r(!6n&r ="r& r&!on(tr!t"on on +

*+t"&nt ="t6 +)&o$+(to)+ "( d&(!r"$&d$&o= "n +n ot"n& 2or).

I. An&(t6&("+

- G&n&r+, &"t6&r t6ro6 oro- or

n+(otr+!6&+ rot&.

II. Po("t"on

- S*"n& *o("t"on ="t6 n&!> 60*&r- &4t&nd&d ="t6 2+!&

- 2+!"n *=+rd( 2or )&nt+

&("on(

- 2+!"n to=+rd( t6& o**o("t"&("d& 2or +t&r+ &("on(

III. Pr&**"n +nd dr+*"n

- Pr&**"n o2 t6& or+ !+'"t0,2+!& +nd n&!>.

I8. S>"n In!"("on

- S$)+nd"$+r +nd ($)&nt+"n!"("on(, +$ot #-!) $&o= t6&

"n2&r"or &d& o2 t6& )+nd"$&!ont+"n"n t6& t)or.

- In!"("on !+rr"&d do=n to t6&

*&r"o(t&) o2 t6& "n2&r"or $or- d&r o2 t6& )+nd"$&, !tt"n

t6ro6 )(!&( *+rt"!+r0,t6& *+t0()+ +nd )+((&t&r +nd

*r&(&r'"n t6& )+nd"$+r $r+n!6o2 t6& 2+!"+ n&r'&.

#3


18/30

8. E4*o(r& o2 t6& M+nd"$+r T)or

- T6& (o2t t"((&( )(!&( +nd

)!o(+& +rond t6& t)or +r&d&t+!6&d or (&*+r+t&d to

(>&&ton"& t6& )+nd"$+r t)or+nd +d%+!&nt nor)+ $on&.

- T&&t6 on t6& +nt&r"or +nd *o(t&-

r"or "n&( o2 r&(&!t"on +r&

&4tr+!t&d.

8I. S&)&nt+ R&(&!t"on o2 t6& M+nd"$&

- U("n G"" ="r&, t6& (&)&nto2 t6& )+nd"$& !ont+"n"n t6&

t)or "( r&(&!t&d ="t6 + #-!)

+nt&r"or +nd *o(t&r"or )+r"n.

8II. KIRSCHNER IRE RECONSTRUCTION

- A )&d") ("& .5 )) or $"- &r K"r(!6n&r ="r& "( !t "nto

t6& *ro*&r &nt6 +nd $&nt =6&r&!r'&( +r& n&&d&d ("n t6&

r&(&!t&d )+nd"$& +( + t&)*+t&.

- E+!6 &nd o2 t6& ="r& "( "n(&rt&d"nto t6& )&d+ o2 t6& )+nd"$-

+r &nd(.

- T6& ="r& "( +n!6or&d (&!r&0 to

t6& $on&( ("n (t+"n&(( (t&&

="r& /-.

8III. H&)o(t+("(

I. Irr"+t"on

#5


19/30

. Co(r& o2 ond

- M!o(+ =ond "( !o(&d ("n+$(or$+$& /- (tr&( (!6 +(

C6ro)"!, 8"!r0 or D&4on.

- A dr+"n "( (&d +( "nd"!+t&d.

- T6& !t+n&o( =ond "( !o(&d

("n non-+$(or$+$& 3- (tr&(

(!6 +( n0on, ("> or !otton.T6& (tr&( +r& r&)o'&d +rond

t6& 2ort6 *o(t-o* d+0.

I. Dr&(("n

B&o= +r& (o)& *o"nt&r( "n t6& *r&-o*

+nd *o(t-o* !+r&:

PRE-OP

#. Or+ 60"&n& "( &n(r&d.

. Intr+'&no( +nt"$"ot"!( 2or r+)-

*o("t"'& +&ro$&( +nd +n+&ro$&(+r& "'&n ="t6"n on& 6or $&2or&

!tt"n t")&.

POST-OP

#. N+(o&(o*6+&+ t$& 2&&d"n "("n(t"tt&d (oon +2t&r t6& o*&r+-

t"on +nd !ont"n&d 2or on& =&&>.T6& 2&&d"n t6ro6 t6& t$&

(&r'&( to r&(t t6& r&!on(tr!t&d%+= +nd to >&&* t6& or+ !+'"t0 +(

!&+n +( *o(("$&.

. +t&r *&r o( "( "'&n on t6&

(&!ond *o(to* d+0 *r")+r"0 to!6&!> 2or + )!o(+ &+>.

#?


20/30


21/30

no( r+2t. Ann A!+d M&d S"n+*or&.

#3:/1, #975.

3. E2&)"o G: A)&o$+(to)+ Pr&+)&o-

$+(to)+ o2 t6& )+4"+ +nd )+nd"$&.P6" J Sr S*&! :#11, #953.

5. L+=(on , Lo(!+o LJ, B+&> S, B"&r

HF,Kr&(*" YP: E4*&r"&n!& ="t6 "))&d"+t&

+nd d&+0&d )+nd"$+r r&!on(tr!t"on.

L+r0no(!o*& 9:3, #97.

?. Lor& JM Jr: An At+( o2 H&+d +nd N&!>Sr&r0, /rd &d. P6"+d&*6"+: .B.

S+nd&r( Co., #977, * 35-5#.

7. S!6d&0 MK, H+'o( AG, Stron E, &t +:A)&o$+(to)+ o2 )+4"+ +nd )+nd"$&.

C+n!&r //:/1, #9?1.

9. S!6=+rt HC: M+nd"$+r r&!on(tr!t"on("n t6& D+!ron-Ur&t6+n& *ro(t6&("(

+nd +to&no( !+n!&o( $on&: A

r&'"&= o2 / !+(&(. P+(t R&!on(tr

Sr ?/:/7?, #971.

#.S6on( AR: G&n&r+ *r"n!"*&( o2 *r")+- r0 +nd +t& r&!on(tr!t"'& (r&r0. In

M!+rr"& DG, Ad+)( GL, S6on( AR,

Bro=n& GA &d(: H&+d +nd N&!> C+n!&r.

C"n"!+ D&!"("on( +nd M+n+&)&ntPr"n!"*&(. C6"!+o: Y&+r Boo> M&d"!+

P$"(6&r(, In!. #975. * #3-#9.

#9


22/30



POST-TEST

A /-0&+r-od 2&)+& *r&(&nt( ="t6 +

1-!) $on0-6+rd )+(( +t 6&r !6"n. T6& )+((=+( not&d 5 )ont6( +o. T6&r& +r& no

ot6&r +$nor)+ 2"nd"n( on *60("!+

&4+)"n+t"on.

#. 6+t =" 0o do n&4t C6oo(& on&

+. R+d"or+*6$. B"o*(0

. I2 0o =+nt to do + $"o*(0, =6+t

=" 0o do C6oo(& on& +. N&&d&

$. S&!t"on !. E4!"("on

/. I2 0o =+nt to do + $"o*(0, nd&r

=6+t +n&(t6&("+ =" 0o do "t

C6oo(& on&

+. Non&$. Lo!+ +n&(t6&("+

!. G&n&r+ +n&(t6&("+

1. I2 0o =+nt to do + r+d"or+*6,

=6+t *ro!&dr& =" 0o r&


23/30

M+t!6 t6& r+d"or+*6"! 2"nd"n( "n

Co)n I ="t6 t6& d"+no("( "n Co)n II.

I II

3. Sn$r(t A. O(t&o)0&"t"(+**&+r+n!& B. In2+))+tor0

5. L0t"! !6+n&( &("on ?. Mt"o!+r C. M+"n+nt

r+d"o!&n!"&( &("on

7. Un"o!+r D. A)&o$+(to)+

r+d"o!&n!0 E. C6ondro(+r!o)++t t6& +*&4 o2 F. D&nt"&ro(

+ toot6 !0(t 9. R+d"o!&n!0 +t G. R+d"!+r !0(t

t6& !ro=n o2 +n H. O(t&o(+r!o)+

n-&r*t&d toot6

#. I2 t6& r+d"or+*6 (6o=( 2"nd"n(

t6+t )+0 &"t6&r $& + *r")+r0 or)&t+(t+t"! !+n!&r, 0o =od

C6oo(& on& +. Do + $"o*(0

$. Do + )+nd"$&!to)0

!. Loo> 2or + *o(("$& *r")+r0

##. I2 t6& r+d"oo"! d"+no("( "( +

to((-* $&t=&&n + d&nt"&ro( !0(t+nd +n +)&o$+(to)+, 0o =od

C6oo(& on&

+. Do + *r&o* $"o*(0

$. Do +n "ntr+o* 2ro&n-(&!t"on$"o*(0

!. Do +n &4t"r*+t"'& *ro!&dr& ="t6- ot + $"o*(0

#


24/30

#. I2 t6& r+d"oo"! d"+no("( "(

&


25/30

C6oo(& t6& +**ro+!6 t6+t =" $& )o(t

+**ro*r"+t& =6&n do"n +n &4t"r*+t"'&

o*&r+t"on on t6& t0*& o2 )+nd"$+r t)or("(t&d "n Co)n I.

I II

1. O(t&o)0&"t"( A. Intr+or+3. R+d"!+r !0(t +**ro+!6

5. D&nt"&ro( !0(t B. E4tr+or+

?. A)&o$+(to)+ +**ro+!6

7. Ant&r"or "n"'o- +'&o+r !+n!&r

9. O(t&o(+r!o)+/. C6ondro(+r!o)+

B&o= "( + "(t o2 d"22&r&nt t0*&( o2

&4t"r*+t"'& *ro!&dr&( on t6& )+nd"$&.Ind"!+t& =6&t6&r + r&!on(tr!t"'&

*ro!&dr& "( n&&d&d +2t&r &4t"r*+t"on $0*+!"n YES or NO "n t6& $+n>( *ro'"d&d.

/#. Cr&tt+&

/. E4!"("on

//. M+r"n+ )+nd"$&!to)0

/1. S&)&nt+ )+nd"$&!to)0/3. Tot+ )+nd"$&!to)0

M+t!6 t6& !o)*"!+t"on( "n Co)n I

="t6 t6& t0*&( o2 r&!on(tr!t"on 2or

)+nd"$+r d&2&!t( "n Co)n II.

I II

/5. In2&!t"on A. Bon& +tor+2t/?. R&%&!t"on B. Pro(t6&("(

/7. R&(or*t"on C. Bot6/9. Non-n"on

1. E4*&n("'&

1#. Lon&r o*&r+t"n t")&

1. Gr&+t&r *o(to* *+"n

/


26/30

1/. A !ontr+"nd"!+t"on to + r&!on(-

tr!t"on ("n + K"r(!6n&r ="r& "(

C6oo(& on&: +. Cont+)"n+t&d $&d

$. In2&!t&d $&d !. H& d&2&!t

d. M+"n+n!0 ="t6 *ro$+$""t0 o2r&!rr&n!&

&. Non& o2 t6& +$o'&

S**o(& 0o +r& to *&r2or) +(&)&nt+ )+nd"$&!to)0 ="t6 K"r(!6n&r

="r& r&!on(tr!t"on on + /-0&+r-od2&)+& ="t6 + t)or o!+t&d +t t6& )&nt)

o2 t6& )+nd"$&. For)+t& + *r&o*,

"ntr+o*, +nd *o(to* *+n o2 )+n+&)&nt.

Foo= t6& ot"n& *ro'"d&d +nd d&(!r"$&+( n&!&((+r0.

Pr&o* Pr&*+r+t"on(

11. Or+ 60"&n& -

13. Ant"$"ot"!( -

15. In(tr)&nt( +nd & +nd 2+!& -

S>"n In!"("on 19. Lo!+t"on -

3. 6+t )(!&( =" $& tr+n(&!t&d

$&2or& r&+!6"n t6& *&r"o(t&) -

3#. 6+t n&r'& n&&d( to $& "d&nt"2"&d+nd *r&(&r'&d -

1


27/30

E4*o(r& o2 t6& M+nd"$+r T)or

3. Ho= -

S&)&nt+ M+nd"$&!to)0

3/. 6+t "n(tr)&nt to (& -

31. M+r"n o2 r&(&!t"on -

K"r(!6n&r "r& R&!on(tr!t"on

33. T&!6n"


28/30



ANSERS TO POST-TEST

#. A #5. A /#. NO

. B #?. C /. NO/. B #7. C //. NO

1. A #9. C /1. YES

3. H . E /3. YES

5. C #. E /5. C?. D . D /?. B

7. G /. A /7. A9. F 1. A /9. A

#. C 3. A 1. B

##. C 5. A 1#. A

#. C ?. B 1. A#/. A 7. A 1/. E

#1. B 9. B #3. E /. B

11. Mot6 =+(6, tr&+t)&nt o2 d&nt+

!+r"&(, d&nt+ !&+n("n

13. Ant"$"ot"!( 2or Gr+)-*o("t"'& +&ro$&(

+nd +n+&ro$&(15. G"" ="r&, *"&r(, dr""n "n(tr-

)&nt, K"r(!6n&r ="r&, (t+"n&(( (t&&="r&, ="r& !tt&r

1?. G&n&r+ +n&(t6&("+, &"t6&r oro- or

n+(otr+!6&+, *r&2&r+$0 n+(otr+!6&+

17. N&!> 60*&r&4t&nd&d +nd 2+!& 2+!"n*=+rd(

19. S$)&nt+ "n!"("on =6"!6 )+0 &4t&ndto ($)+nd"$+r +r&+

3. P+t0()+ )(!&(3#. M+nd"$+r $r+n!6 o2 t6& 2+!"+ n&r'&

3. D&t+!6 (o2t t"((&( )(!&( +nd

)!o(+& 2ro) t6& )+nd"$+r t)or

+nd +d%+!&nt nor)+ $on&3/. G"" ="r&

31. On& !&nt")&t&r

5


29/30

33. Ct +nd $&nd + )&d")-("&d

K"r(!6n&r ="r& ("n t6& r&(&!t&d

)+nd"$& +( t&)*+t&@ "n(&rt t6& ="r&"nto t6& )&d+ o2 t6& t=o )+nd"-

$+r &nd(@ (&!r& t6& K"r(!6n&r ="r&("n (t+"n&(( (t&& ="r&.

35. A$(or$+$& /- (tr&(3?. For dr+"n+& +nd +( +n "nd"!+tor

dr+"n.

37. R$$&r dr+"n P&nro(&

39. Non+$(or$+$& 3- (tr&(5. N+(o-&(o*6+&+ or n+(o+(tr"! t$&

2&&d"n 2or +$ot on& =&&>.5#. An+&("!( +nd +nt"$"ot"!( 2or Gr+)-

*o("t"'& +&ro$&( +nd +n&ro$&( t6ro6

t6& n+(o-&(o*6+&+ t$&.

5. A$ot 2or =&&>( *o(to*, "2 t6&r& +r&no !ontr+"nd"!+t"on(.

5/. +. In2&!t"on $. M!o(+ &+>

!. R&%&!t"on d. D"(*+!&)&nt o2 K"r(!6n&r ="r&

&. Br&+> o2 K"r(!6n&r ="r&

?


30/30

RECOMMENDED FOLLO-UP

A2t&r !o)*&t"n t6"( (&2-

"n(tr!t"on+ *ror+), t6& (&r "( +d'"(&dto d"(!(( t6"( *ror+) ="t6 6"( t&+!6&r(

+( =& +( 6"( *&&r(. H& "( +(o (tron0+d'"(&d to +**0 =6+t 6& &+rn( "n t6&

!"n"!(, *r&2&r+$0 nd&r (*&r'"("on o2

6"( t&+!6&r( +t &+(t "n"t"+0.

ABOUT THE AUTHOR

DR. REYNALDO O JOSON "( !rr&nt0 +n

+(("(t+nt *ro2&((or +t t6& Un"'&r("t0 o2t6& P6""**"n&( Co&& o2 M&d"!"n&. H&

"( + (t+22 )&)$&r o2 t6& D"'"("on o2 H&+d+nd N&!>, Br&+(t, E(o*6+(, +nd So2t

T"((& Sr&r0 o2 t6& D&*+rt)&nt o2Sr&r0 +t t6& P6""**"n& G&n&r+

Ho(*"t+.

ACKNOLEDGEMENT

DR. ALBERT B. DACO

COPYRIGHT

#99

7

tumors of the mandible part 3: surgical decision making

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