PMC4608166_01
A - note the depression in the left mandible body; in B - note the shortening of the anteroposterior mandibular length.
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External examination revealed a depression in the projection of the left mandibular body,l shortening of the mandibular length (Figure 1A and B) and mobility of the mandibular body, which was adequately covered by soft tissue (Figure 2).
Intraoral aspect. It is possible to note the segmental defect between the wood spatulas.
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External examination revealed a depression in the projection of the left mandibular body,l shortening of the mandibular length (Figure 1A and B) and mobility of the mandibular body, which was adequately covered by soft tissue (Figure 2).
A - Frontal view of 3D CT reconstruction demonstrating the initial aspect of the mandibular fracture; B - Frontal view of the prototype, mimicking the CT image shown in A; C - The segmental defect measured 5 cm; D - The acrylic was placed in the defect to re-establish the original anatomy of the mandible.
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A 5 cm defect could be determined, which was filled with auto-cure resin to maintain the structural positions (Figure 3).
A - A long prebent plate molded to the prototype, from mandibular ramus to symphysis; B - The occlusal guide in position.
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A - An extended submandibular approach was enough to see all defects and adapt the whole plate and graft without excessive tissues traction; B - The plate with at least 4 screws was fixed to each side of the defect; C - corticocancellous bone graft from the left iliac crest, which size and shape were adequate to reproduce an ideal alveolar ridge; D - The graft was fixed to the plate, spanning the defect.
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Additional graft stability was gained with a four holes 2.0 system plate fixed to the graft (Figure 5).
Five months CT - 3D reconstruction control; final aspect.
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Physiotherapy began with the objective of improving his maximal open mouth until 40 mm was reached and muscular function was re-established (Figure 6).
Aesthetic view and mouth opening amplitude after 12 months of the surgery.
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Figure 7 shows the long-term postoperative aesthetics vision and the amplitude of mouth opening.