24-year-old Ms. Li is young and beautiful, cheerful personality, but recently she is worried, depressed, Ms. Li what happened? It turns out that her right jaw has been slowly enlarging and getting more and more serious, and her originally beautiful face is now obviously “out of shape”, which causes great psychological pressure and a lot of inconvenience to Ms. Li’s life, after many inquiries, Ms. Li and her family came to the Guangdong Provincial Oral Hospital Maxillofacial Surgery Department, and after detailed clinical and imaging examinations, it was confirmed that After detailed clinical and imaging examinations, it was confirmed that the lesion in Ms. Li’s right mandible was an enameloblastoma. Enamel-forming cell tumor is a common tumor in the oral and maxillofacial region, which grows expansively and has no obvious discomfort in the early stage, but can affect the appearance and destroy the jaw bone or even cause pathological fracture in the later stage due to local expansion. Therefore, the complete treatment is to perform segmental segmental resection of mandible. Since the tumor had already invaded most of the right mandible when Ms. Li was seen, the surgery had to remove the tumor as well as the invaded mandible, teeth and other tissues together, and the extensive mandibular defect caused by the surgery, if not repaired in time, would definitely cause Ms. Li’s facial deformity and loss of masticatory function, which would seriously affect her quality of life. The treatment plan determined by the maxillofacial surgeons of Guangdong Provincial Oral Hospital was segmental resection of the right mandible + vascularized free fibular muscle flap to reconstruct the mandible, commonly known as “jaw replacement”. People have heard of “kidney replacement”, “heart replacement” and “bone marrow replacement”, can the jaw be replaced as well? The answer is yes. In the past, patients with jaw bone defects could only use autologous rib bone or metal bone plate to repair the defect, but there are disadvantages such as poor appearance after repair, easy infection, and failure to restore chewing function. Mandibular reconstruction using free fibula composite tissue flap grafting technique is a commonly used method for mandibular reconstruction in recent years at home and abroad. The fibula is a non-major weight-bearing bone of the lower leg, and the lower end participates in the composition of the ankle joint, which has a role in strengthening joint stability. It is generally believed that as long as the 5-7 cm bone segment of the lower end of the fibula is preserved, the stability of the ankle joint will not be affected and there is no significant impact on the lower limb function of the patient after surgery. The fibula has the characteristics of dual blood supply in the periosteum and canal, which can be made after multiple osteotomies and three-dimensional shaping of various shapes to better restore the morphology of the reconstructed mandible. The fibula has a stable blood vessel, a large caliber, a good match with the cervical vessels, a relatively easy vascular anastomosis operation, and a high graft success rate. In addition, fibula is suitable for osseointegrated dental implant placement, which can effectively restore masticatory function. Currently, the free fibula flap is internationally known as the “gold standard” for mandibular bone repair. Despite this, Ms. Li and her family still had doubts: Is it risky to “replace the jaw”? In recent years, the Department of Maxillofacial Surgery of Guangdong Provincial Stomatological Hospital has performed vascularized peroneal muscle flap graft mandibular reconstruction on more than 30 patients with extensive mandibular defects caused by tumors or inflammation, with a success rate of nearly 100%, making the surgery extremely safe and reliable. Ms. Li and her family were finally relieved of all their concerns and happily underwent the right mandible and tumor removal and the vascularized fibular flap graft mandible reconstruction. With the joint efforts of Director Weijian Ai, Dr. Shuguang Liu, Dr. Xiuwen Luan and the entire medical staff, the surgery lasted nearly 6 hours and was a complete success. With the help of Director Song Guangbao of the Department of Prosthodontics of Guangdong Provincial Stomatological Hospital, Ms. Li was able to restore her facial appearance and oral function with the use of fibula flap graft. Now Ms. Li has a happy family, is healthy and happy, and has regained her old confident smile. If she were standing in front of you, you wouldn’t know she had her jaw replaced! The attached picture shows the preoperative and postoperative facial appearance and intra-oral teeth occlusion comparison of the “chin replacement” patient 1. preoperative right jaw expansion 2. postoperative frontal facial symmetry 3. preoperative intra-oral right mandibular gum expansion 4. postoperative right mandibular tooth loss 5. 9 months postoperative missing tooth repair
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