Mandible reconstruction rebuilds the lower jaw after tumour removal, trauma, infection (osteomyelitis) or bone death from radiation or bisphosphonate medicines. It usually uses vascularised bone transferred by microsurgery, most often from the fibula, to restore jaw continuity, chewing, speech and the shape of the lower face.
- AnaesthesiaGeneral
- DurationTypically 6 to 10 hours
- Hospital stayUsually 7 to 14 days
- Back to routineTypically about 6 weeks before strenuous activity
What is mandible reconstruction?
The mandible (lower jaw) is central to biting, chewing and speech and shapes the lower face. Defects from trauma, infection or tumours can impair these functions and change appearance. Reconstruction aims to restore the continuity of the jaw, repair the surrounding soft tissue, and provide enough strength for daily activities.
Vascularised bone flaps, transferred with microsurgery, generally give the best functional and cosmetic results. The fibula flap is considered the best option: it gives a long segment of bone that tolerates reshaping well, and nerve reconnection is possible. The iliac crest flap provides naturally curved bone and is a second-line choice when the fibula is unavailable. The scapular flap supplies a large amount of skin and soft tissue, and the radial forearm osteocutaneous flap gives soft, pliable tissue for patients with limited bone needs; no more than about 30% of the radius circumference should be taken to avoid fracture.
Dentures or osseointegrated (dental) implants may later be used to support chewing, speech and facial shape. Implants can anchor dentures even without an alveolar ridge.
Who is mandible reconstruction for?
- Patients needing removal of benign or malignant jaw tumours
- People with jaw defects after trauma
- Patients with osteoradionecrosis (bone damage after radiotherapy)
- People with bisphosphonate-related osteonecrosis of the jaw
- Patients with chronic osteomyelitis of the mandible
How is it done?
- Physical examination, facial assessment, scans and photographs for planning
- Removal of the diseased or damaged portion of the jaw
- Harvest of a vascularised bone flap (fibula, iliac crest, scapula or radial forearm)
- Shaping and fixing the bone with plates, and joining its vessels to neck vessels under a microscope
- Later rehabilitation with dentures or dental implants where suitable
What is recovery like?
- Mouth opening is limited at first and pressure on the jaw is avoided for several days
- Feeding is usually by nasogastric tube until swelling settles, then clear liquids, then soft foods
- If the leg is the donor site, it is kept elevated for about three weeks and a walker is used for a few days
- Mouth rinses keep the mouth clean and moist
- Heavy lifting and strenuous activity are usually avoided for about six weeks
What are the risks?
- Flap failure from blood vessel blockage, sometimes needing re-operation
- Infection or wound breakdown
- Plate exposure or problems with bone healing
- Donor-site problems such as leg weakness, pain or wound healing issues
- Changes in bite, speech, swallowing or facial symmetry
Why choose Dr. Jithendran?
- Dual training in orthopaedics (MS) and plastic surgery (MCh, DNB), with hand and microsurgery experience from Ganga Hospital, Coimbatore
- Consults at five hospitals across Bengaluru, with 24×7 availability for emergencies
- Clear explanations in English, Tamil, Hindi and Telugu, and time to answer every question
- Strict sterilisation and patient-privacy standards
Frequently asked questions
Why is the fibula used to rebuild the jaw?
The fibula, a thin bone in the lower leg, provides a long, strong segment of bone with a reliable blood supply that can be cut and shaped to match the curve of the jaw. It can also carry skin, and dental implants can be placed in it. Most people walk normally without it.
How will I eat after mandible reconstruction?
At first, nutrition is usually given through a nasogastric tube while swelling settles. You then progress to clear liquids and soft foods as advised. Mouth rinses help keep the mouth clean, and you should avoid pressure on the jaw in the early days.
Can I have dental implants after jaw reconstruction?
Often, yes. Osseointegrated implants can be placed into the reconstructed bone, usually once it has healed, and used to anchor dentures. Implants can support dentures even without an alveolar ridge, which helps chewing, speech and appearance.
How should I prepare for jaw reconstruction?
You will have a physical examination and assessment of your facial anatomy, and your face may be photographed for planning. Avoid alcohol, which raises the risk of bleeding, infection and a longer hospital stay, and tell your surgeon about all medicines you take.
When should I call the surgeon after going home?
Contact the surgeon immediately for uncontrolled pain, fever, increasing redness or discomfort at the incision, shortness of breath or fluid draining from the surgical site. Drink plenty of water and eat high-fibre foods, as pain medicines can cause constipation.
