[Lower jaw myxoma in an early age pediatric patient: comprehensive rehabilitation aspects]

The article presents a clinical example of the removal of myxoma in a 14-month-old child with half resection of the mandible, disarticulation and one-stage replacement of the defect with a «Carbopol» endoprosthesis. The period of postoperative follow-up was 6.5 years, during which there were no signs of relapse. 2 years after the operation, complete coverage of the endoprosthesis with bone regenerate was determined, the configuration of which corresponded to the healthy branch of the mandible. The remodeling of the condylar and coronoid processes by this regenerate was noted, as well as the formation of the tooth germ 3.8 above the endoprosthesis.

[Reconstruction of the lower alveolar nerve during mandible resection due to benign tumors]

OBJECTIVE

Development of a method for reconstruction of the inferior alveolar nerve and evaluation of its effectiveness in resection of the lower jaw for benign tumors.

MATERIAL AND METHODS

In the period from 2018 to 2020, 10 resections were performed for benign odontogenic neoplasms (myxoma, ameloblastoma, osteoblastoclastoma) at the age of 18 to 60 years. Tactile, pain and temperature sensitivity were subjectively studied. The assessment of subjective sensitivity was carried out five times: before the operation, after 21 days, after 3.6 months and a year after the operation, an electromyograph «SYNAPSIS» was used for an objective assessment of sensitivity. The studies were conducted twice: 21 days after the operation and 12 months later. Reinervation was carried out by two methods. Method I: by transferring the insertion from the calf nerve and applying end-to-end neuroanastomoses between the proximal and distal ends of the inferior alveolar nerve (5 patients); method II: transferring the insertion from the calf nerve to the lingual nerve. Neuroanastomoses are applied periepineurally between the distal end of the inferior alveolar nerve and the lingual nerve «end to side» (5 patients).

RESULTS

After 12 months, all types of sensitivity were restored in the control group in all patients, and in the second group in 80%. All patients had areas of hyposthesia in terms of temperature and tactile sensitivity. The results of trigeminal evoked potentials were negative in all patients 21 days after surgery, and peaks of evoked potentials were recorded in 9 (90%) patients 12 months later.

CONCLUSION

These reconstruction techniques are effective both when the proximal end of the inferior alveolar nerve is preserved, and when it is impossible to preserve it. With minimal donor damage, the sensitivity of the lower lip is restored, which significantly improves the quality of life of patients and their social adaptation.