Up to this point, surgeons only removed the area around the tumor, but Salam Salman, MD, DDS, a UF Health oral and maxillofacial surgeon, recommended removing a lot more through a segmental mandibulectomy.
“A lot of these patients require resections or a big part of their lower or upper jaw removed and reconstructed,” Salman said.
Fernandes and Salman encouraged Cramer to have the segment of her lower jaw and teeth, where the tumors continuously formed, removed and replaced with a portion of her fibula, the smaller bone in the lower leg located between the knee and ankle.
The complicated reconstructive process used to be completed in stages over the course of 18 months. Fernandes, Salman and their team of specialists can complete the entire procedure at once during a six- to eight-hour surgery.
“Generally you would stage this out into multiple steps,” Salman said. “You would perform a fibula free flap to reconstruct the defect. Wait about four to six months and then go back in to put in the dental implants. And then wait about four to six more months to go back in to put teeth on top of it.”
Using 3-D imaging software, virtual surgery simulation and prefabricated cutting guides, oral and maxillofacial surgeons can customize and accurately plan the procedure, as well as place a dental prosthesis that aligns with the patient’s natural teeth to near perfection.
“Every single patient will be different,” Fernandes said. “Every single patient’s facial structure is different. The mandible is different. The tumor is different, so no two cases are the same.”