Beyond resection: Minimally invasive jaw in a day with nerve reconstruction. A case report

Abstract

Odontogenic myxoma is a benign but locally invasive tumor arising from the tissues that form the teeth. Its infiltrative growth pattern makes complete excision challenging, increasing the risk of recurrence. Primary treatment involves surgery, often requiring resection of a segment of bone. To reconstruct the bony defect and restore function, techniques such as the use of a free fibula flap with hard and soft tissue reconstruction and nerve grafting are often utilized. This study presents the case of a 15-year-old patient who underwent microvascular reconstruction of the mandible using a free fibula flap with immediate implants and dental prosthesis placement and nerve reinnervation with peripheral nerve allografts following resection of a mandibular odontogenic myxoma. Virtual preoperative 3D planning was employed to increase the accuracy of the surgical reconstruction. The surgical procedure involved a partial mandibulectomy, harvesting of a free fibula flap and microvascular anastomosis to the facial artery and vein in the neck, and immediate dental implant placement into the fibula in a single surgical stage procedure. To restore sensation to the lower lip and chin, an peripheral nerve allograft (Avance, Axogen, Inc, Alachua, FL, USA) was used to reconstruct the bilateral inferior alveolar nerves that were sacrificed with the mandibular resection. The nerve allograft is a cadaveric nerve that is treated with an enzymatic process that removes all cellular components from the nerve leaving only the endoneural tubes to guide and enhance nerve regeneration. The surgery and postoperative patient course was smooth and uneventful and the patient demonstrated excellent functional and aesthetic outcomes at the three-year follow-up with normal jaw function, mastication, esthetics, and neurosensory recovery. The combination of microsurgery, computer-aided planning, and immediate nerve reinnervation has been proven to be an effective approach for reconstructing large mandibular defects1. The study highlights the advantages of this technique, including reduced surgical time, increased precision, and improved patient outcomes.