Post-Traumatic Maxillo-Mandibular Reconstruction: A Treatment Algorithm for the Partially Edentulous Patient
Jesse A. Goldstein, MD1, Stephen B. Baker, MD, DDS1, Laura Seiboth, MD1, Kristen Klement, BA1, Jeffrey Weinzweig, MD2.
1Georgetown University, Washington, DC, USA, 2Lahey Clinic Medical Center, Burlington, MA, USA.
BACKGROUND: Maxillofacial injuries in the partially edentulous patient present unique challenges that can complicate ideal restoration of occlusion and other associated maxillofacial structures. We present a management algorithm that our service uses in the reconstruction and pre-prosthetic rehabilitation of these complex injuries. Working with an orthodontist and a prosthodontist, the plastic surgeon can optimize the quality of care in these patients.
METHODS: The authors present their experience in the management of six patients who presented for post-traumatic reconstruction with partially edentulous occlusion. The etiologies of injury are as follows: motor vehicle accident (3 patients); gun shot wound (2 patients); and fall (1 patient). All of these patients were treated using a team approach that included the input of an orthodontist, a prosthodontist, and a plastic surgeon. Two patients required osteotomies to reposition their jaws, five patients required supplemental alveolar bone grafting, and all patients required placement of osseointegrated implants.
RESULTS: Every patient receiving implants experienced a 100% (13/13 implants) success rate in osseointegration. Following the authors’ management algorithm resulted in functional positioning for all implants as well as adequate supporting bone and soft tissue coverage. All three specialists were satisfied with the outcomes resulting from this team approach to maxillofacial injury. The management algorithm presented by the authors is seen in figure 1.
CONCLUSIONS: Pre-prosthetic rehabilitation of maxillofacial trauma in the partially edentulous patient population requires a team approach with orthodontists and prosthodontists and can be a rewarding stage of care for plastic surgeons. The proposed management algorithm should serve as a guide to the steps necessary for complete maxillo-mandibular reconstruction and the role of appropriate dental specialists in dental rehabilitation.