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Methods of osseous reconstruction of the mandible following surgical resection.

Osseous reconstruction of the surgically resected mandible has presented, for some time, a considerable surgical problem. This paper presents the results of a series of experimental investigations evaluating the various morphologic and immunologic types of autogenous bone grafts in the reconstruction of the surgically resected mandible. The osteogenic inductive effect of hemopoietic marrow in combination with autogenous cancellous bone is reviewed and examples of this inductive effect are cited. The application of the particulate graft of cancellous bone and marrow to the restoration of large areas of lost mandibular bone is described. In this application, the particulate graft is used with a compatible metal implant designed to offer an optimal grafting system for the reconstruction of large areas of the mandible. The metallic implant, in addition to containing the bone graft, serves to control and fix the host bone fragments and lessens the period of intermaxillary immobilization necessary for healing. Normal aesthetic mandibular contour is restored and routine dental prosthesis may be constructed over the reconstructed mandible. It is felt that this system offers the optimal approach, through the combination of implant metals and highly osteogenic graft tissues, to the reconstruction of the mandible following surgery.