Stanford Head and Neck Center
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Reconstruction and Rehabilitation Program
Computer-Assisted Mandible (Jaw) Restoration
Reconstruction of the mandible requires a unique set of skills different from other reconstructive techniques. The unique nature and function of the jaw and teeth places additional demands on the reconstruction to be both durable and accurate. Our goals of reconstruction are to maximize your mandibular function, while providing an optimal aesthetic result.
Changes following treatment of head and neck cancer makes every case unique and always requires a comprehensive strategy. Our evaluation of each patient begins with an assessment of the pathology, whether due to tumor, radiation sequela, or osteoradionecrosis. Assessment of current or expected deficits in sensation, lip movement, tongue volume and movement, and facial skin are all taken into account when designing a reconstruction.
The process of mandible reconstruction begins with a CT scan of the mandible. The CT scan must have each image no more than 1mm apart to provide enough data for the subsequent steps. This scan is then uploaded into a 3D-modeling program that creates an exact digital replica of the patient’s jaw. These programs allow us to manipulate the mandible in a virtual environment. We use these programs to decide which segments of bone to remove and how to re-contour the remaining pieces to optimize the reconstruction. This is particularly important when patients come to us having had a prior mandible fracture or when they are already missing a segment of their mandible.
After we finalize a digital design for the reconstructed mandible, this data is sent to a 3D-printer to create a plastic model of the reconstructed jaw. This model is optimized for each patient, and is what we strive to achieve in the subsequent reconstructive surgery. Using the model, we then have titanium plates customized to this shape. These plates are an integral part of mandible reconstruction and are used to hold all of the moving bony segments in the correct position until they are fully healed into place. By having these plates designed before we reach the operating room, we can determine the final mandible shape and position before we get started.
All of this takes place before the day of surgery. On the day of the operation, the mandible reconstruction is coordinated with all of the surgical teams involved. The reconstructive team is led by Vasu Divi, MD, a head and neck microvascular surgeon who focuses on mandibular reconstruction. Using the previously designed plates, and a vascularized bone graft from the fibula or scapula, Dr. Divi completes the surgery by recreating the jaw based on the computer-assisted model design.
Stanford OHNS Head & Neck Microvascular Surgeon
Appointments for evaluation can be made by contacting:
(650) 723 - 5400