Mandibular continuity defects are commonly seen after tumor resection, osteomyelitis or maxillofacial trauma. Three-dimensional reconstruction of these mandibular segmental defects is critical for proper mandibular functioning and esthetics. Various methods used to reconstruct such defects include bridging reconstruction plates, modular endoprosthesis, non-vascularized and vascularized bone grafting with stock reconstruction plate or patient specific implants (PSI) and tissue engineering bone transfer. But in the recent years, literature documents use of PSI only alloplastic reconstruction as an alternate to microvascular bone flap reconstruction. Representative cases enumerate current practice of \'patient specific implant only\' mandibular reconstruction and its pitfalls. This article discusses current status of literature on PSI\'s, choice of indications for \'PSI only\' mandibular reconstruction and also proposes guidelines for safe practice of patient specific implant reconstruction of mandible.

The use of finite element analysis (FEA) has increased rapidly over the last decennia and has become a popular tool to design implants, osteosynthesis plates and prostheses. With increasing computer capacity and the availability of software applications, it has become easier to employ the FEA. However, there seems to be no consensus on the input variables that should be applied to representative FEA models of the human mandible. This review aims to find a consensus on how to define the representative input factors for a FEA model of the human mandible. A literature search carried out in the PubMed and Embase database resulted in 137 matches. Seven papers were included in this current study. Within the search results, only a few FEA models had been validated. The material properties and FEA approaches varied considerably, and the available validations are not strong enough for a general consensus. Further validations are required, preferably using the same measuring workflow to obtain insight into the broad array of mandibular variations. A lot of work is still required to establish validated FEA settings and to prevent assumptions when it comes to FEA applications.

Mandibular defect is one of the common defects of maxillofacial region, which can seriously affect the appearance, chew and speech. The ultimate goal of functional reconstruction of mandibular defect is to restore mandibular appearance, denture and occlusal function. Vascularized bone grafting is an effective method for reconstruction of mandibular defect, especially in treatment of large defect. However, functional reconstruction of mandibular defects involves multiple specialties, many technical details and long treatment cycle, resulting in a small proportion of functional reconstruction. To establish standard operating procedures, Society of Oral Maxillofacial Rehabilitation, Chinese Stomatological Association has organized a lot of experts to establish expert consensus statement on reconstruction principle for mandibular defect, referred to standard procedure of indication, preoperative evaluation, choice of donor site, digital technology aided surgery, recommendations of the operation in the process of residual mandibular position fixed, the mandibular body molding denture and common post-operative complications, in order to promote the reconstruction of mandibular defect treatment and improve the quality of reconstruction.
下颌骨缺损是颌面部常见缺损之一，可严重影响患者容貌和咀嚼、语言功能，下颌骨缺损修复重建治疗的最终目标是恢复下颌骨外形、义齿修复以及咬合功能重建，血管化自体骨移植是下颌骨缺损修复重建的有效手段，其治疗大型缺损的优势更明显。但下颌骨缺损修复重建治疗涉及多个专业，技术细节多、治疗周期长，导致最终实现功能重建的比例并不高。为规范下颌骨缺损修复重建治疗流程，中华口腔医学会口腔颌面修复专业委员会牵头组织国内多名从事下颌骨重建工作的专家共同讨论，形成下颌骨缺损修复重建治疗专家共识，针对下颌骨缺损修复重建治疗的适应证选择、术前评估、供区选择、数字化技术的辅助提出治疗规范，针对手术过程中的残余下颌骨位置固定、下颌骨体部成形等操作、重建术后的义齿修复和常见并发症提出治疗推荐，促进下颌骨缺损修复重建治疗的推广，提高修复重建质量。.

Comparing accuracy results for mandibular reconstructions using computer-assisted surgery (CAS) is limited due to heterogeneity in image acquisition, extent of mandibular resection, and evaluation methodologies between studies. We propose a practical, feasible and reproducible guideline for standardizing evaluation methods to allow valid comparisons of postoperative results and facilitate meta-analyses in the future. It offers a guide to imaging, data comparison, volume assessment of 3-dimensional models, classification of defects, and it also contains a quantitative accuracy evaluation method.

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. The reconstructive needs following ablative surgery for head and neck cancer are unique and require close attention to both form and function. The vast experience accrued with microvascular reconstructive surgery has meant a significant expansion in the options available. This paper discusses the options for reconstruction available following ablative surgery for head and neck cancer and offers recommendations for reconstruction in the various settings. Recommendations • Microsurgical free flap reconstruction should be the primary reconstructive option for most defects of the head and neck that need tissue transfer. (R) • Free flaps should be offered as first choice of reconstruction for all patients needing circumferential pharyngoesophageal reconstruction. (R) • Free flap reconstruction should be offered for patients with class III or higher defects of the maxilla. (R) • Composite free tissue transfer should be offered as first choice to all patients needing mandibular reconstruction. (R) • Patients undergoing salvage total laryngectomy should be offered vascularised flap reconstruction to reduce pharyngocutaneous fistula rates. (R).