Mandibular Defects

• Class I - Radical alveolectomy with preservation of mandibular continuity
• Class II - Lateral resection of the mandible distal to the cuspid area
• Class III - Lateral resection of the mandible to the midline
• Class IV - Lateral bone graft and surgical reconstruction
• Class V - Anterior bone graft and surgical reconstruction
• Class VI - Anterior mandibular resection without surgical reconstruction

Surgical reconstruction using a bone graft is the best approach that a surgeon can take to correct defects of the mandible. The bone graft restores continuity to the mandible and provides a prosthesis-bearing area. However, surgical reconstruction may be contraindicated in patients receiving radiation therapy or in individuals with residual tumors.

If mandibular resection involves the lower border of the mandible, the remaining segments deviate toward the defect side, backward, and upward. Using intermaxillary fixation for 5-7 weeks following the resection can reduce the deviation. The placement of a resection guidance appliance can also help minimize the deviation. These appliances are temporary and are removed once acceptable occlusal relationship and proper proprioception are attained.

Tongue Defects

Tongue (glossal) defects can be partial or total. Factors influencing prosthetic prognosis of restoring the tongue include the presence or absence of teeth and the type of procedure that is combined with the glossectomy (eg, mandibulectomy, palatectomy, radiation therapy). Patients with partial glossectomy (ie, < 50% of tongue removed) suffer minimal functional impairment and require no prosthetic intervention. Removal of more than 50% of the tongue requires construction of a palatal or lingual augmentation prosthesis.