Practical Reconstructive Techniques Using the Transoral Approach to Segmental Mandibulectomy With Cosmofix: Technical Report

Abstract

This paper introduces a new, less invasive, aesthetic, and functional reconstructive method using a transorally inserted, custom-made Cosmofix fixation plate. Two medication-related cases with stage 3 osteonecrosis of the jaw (MRONJ) are presented. Both procedures required a segmental mandibulectomy as the osteonecrosis had progressed to the mandibular inferior margin and was reconstructed by a transoral approach with a good prognosis. The reconstructed sites were satisfactorily restored with good occlusal conditions and with dentures. No esthetic or functional problems were evident >1 year after surgery. Compared to traditional reconstructive surgery involving facial skin incisions, this technique takes less time, is minimally invasive, is not associated with aesthetic complications, and does not cause facial nerve palsy. Therefore, this procedure may be safely performed in patients with advanced MRONJ who are in poor general condition or older patients.