PMC6954477_01
Preop intraoral photo. Buccal bony expansion is appreciated on manual palpation.
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A 23-year-old caucasian male with severe hemophilia B presented for evaluation of an expansile mass of his right mandible (Figure 1).
Preoperative operative 3D image of tumor involving the mandible. (a) Lateral view. (b) Frontal view: showing cutting guide and planned resection.
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The computed tomography (CT) scan demonstrated a 2.5 cm by 2.5 cm hypodense, expansile lesion with cortical erosion in the right mandibular body (Figure 2).
Showing virtual plan. (a) Fibula cutting guide. (b) Planned mandibular reconstruction with single segment fibula, superior view. (c) Mandibular reconstruction with fibula and immediate implants, submental view.
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The patient opted for segmental resection and reconstruction with a free fibular flap with simultaneous dental implant placement and immediate prosthetic rehabilitation (Figures 3 and 4).
Intraoperative photos. (a) Showing fibula free flap harvest. No abnormal bleeding encountered during harvest or after release of tourniquet. (b) Fibular bone inset at the mandible via transcervical approach with good hemostasis.
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The patient opted for segmental resection and reconstruction with a free fibular flap with simultaneous dental implant placement and immediate prosthetic rehabilitation (Figures 3 and 4).
One-week postoperative photos. (a) Intraoral photo showing provisional prosthesis in place. (b) Photo showing lower extremity donor site with skin graft in place. No issues with postop bleeding.
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The patient had no issues related to hemostasis on follow-up (Figures 5 and 6).
Six-month postoperative photos. (a) Lower extremity donor site. (b) Intraoral photo with prosthesis removed.
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The patient had no issues related to hemostasis on follow-up (Figures 5 and 6).