Upper Jaw (Maxilla)

The upper jaw includes the upper teeth, but it also supports the center of the face, and supports the bones of the nose and the eye sockets. The bone includes cavities (maxillary sinuses), which are located beneath the eye sockets and above the molars, bordering on the nasal cavity on the internal side.

The hard palate separates the oral cavity and the nasal cavity, and is primarily composed of the bone of the upper jaw, though it also includes bones from the back part of the palate.

Reconstruction of the upper jaw is usually necessary after removal of benign or malignant tumors, or after trauma. Partial removal of the upper jaw typically does not require reconstruction, especially if it does not adversely affect the structural stability of the bone or the proximal structures that it supports. Partial removal that also involves removal of the soft tissues attached to it requires the reconstruction of the soft tissues, and in such cases it is worth considering the necessity of reconstructing the osseous defect. Complete removal of the upper jaw requires reconstruction, which can sometimes be performed with a supporting prosthetic device, or, in appropriate situations, by using a free flap that is transplanted to the area of the defect and attached to the recipient blood vessels using microsurgical techniques.

Partial reconstruction of the upper jaw, except in those cases where the teeth and the hard palate are involved, can be performed by using metal implants during the course of surgery, such as a titanium mesh fitted to the defect intraoperatively. It is also possible to reconstruct partial defects of this sort with custom-made synthetic implants created specifically for this purpose using CT imaging of the patient. These implants are made of polyethylene (Medpor), or a methyl methacrylate polymer and calcium hydroxide (HTR), but this reconstruction is usually performed in a separate operation from the ablative surgery. Partial reconstruction of the area of the hard palate and the teeth can be performed using a prosthetic device fitted to the defect by a maxillofacial surgeon. Complete reconstruction of the upper jaw can be performed using an appropriate prosthetic that fills the cavity of the missing upper jaw bone and supports the soft tissues from inside.

A complex reconstruction of a bone defect is performed by transferring a free flap of bone along with the blood vessels supplying it, and connecting it to the blood vessels in the area using microsurgical techniques. Soft tissues such as skin and muscle can be transferred with the bone, as necessary, for the purpose of internal or external covering, as well as filling the internal cavity in the area of the surgery. The most useful donor bone is the fibula from the shin. A section of skin or muscle from the area can be transferred with the bone, and the donor area is closed with a skin graft. In most cases, there is no loss of function of the lower limb after surgery, and the implanted bone, after acceptance, enables the reconstruction of the dentition with appropriate dental implants. 

An additional optional use of a free flap of bone is the use of the scapula or the iliac bones. Skin appropriate for covering can be moved with the bone. Here, also, the functional and esthetic loss is minimal, though these bones generally do not allow the reconstruction of the dentition, and the soft tissue transferred with them is too thick to permit optimal modification.

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