INTRODUCTION
Mandibular reconstruction after trauma or pathology is one of the cornerstones of oral and maxillofacial surgery1.This reconstruction is needed in cases with a large amount of bone loss, comminuted fractures, severe traumas and infections leading to multiple bone sequestrations2.
In the case of infections of the bone, different risk factors may enhance the speed in which the bone is lost, such as age, sex, poor oral hygiene, comorbidities (diabetes, hyperlipemia, autoimmune diseases) and drug abuse (cocaine, cannabinoid, tobacco smoking, hepatic cirrhosis due alcoholism)3, 4, 5, 6, 7-8.
The four basic principles of successful reconstruction are: (1) establish an ideal orthognathic relationship; (2) a flush bone to graft/flap contact; (3) stable bony fixation; and (4) adequate, well-vascularized soft tissue coverage1.
To achieve the previously established principles, the maxillofacial literature describes different surgical treatment plans. One temporary option is the use of external fixation of the mandible. It is considered a closed reduction type and provides semi-rigid fixation for fractured segments2. One of its main advantages is to minimize the possible complications when compared to open surgical treatment for reduction and stabilization of fractures9.
Sometimes the fractured bone contact cannot be achieved due to the level of damage. In such cases grafts may work as a bridge to achieve fusion. Oral reconstruction is a difficult task because of the anatomical, functional and esthetics aspects that have to be taken into account in the surgery. Autogenous bone is the only graft material that possesses osteoconductive, osteoinductive, and osteogenic potential2-10.
This kind of surgical treatment is widely performed in cases such as the reviewed on this case study. Technology has allowed maxillofacial dentists to improve surgical processes over the last few years1. Virtual surgical planning, computer-aided manufacturing and 3D printing gives the surgeon multiple advantages such as mirror the anatomy of the unaffected side, plan osteotomies, manipulate bony segments, fabricate surgical resection guides and create reconstruction plates1.
This case study reports a jaw reconstruction in a 52-year-old male after a previous surgical reconstruction due to trauma that leaded to a case of osteomyelitis with severe bone loss on the body of the mandible.