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Mandibular Reconstruction Based on the Concept of Double Arc Reconstruction

Sarukawa, Shunji MD*; Noguchi, Tadahide DDS; Kamochi, Hideaki MD, DDS*; Sunaga, Ataru MD*; Uda, Hirokazu MD*; Nishino, Hiroshi MD; Sugawara, Yasushi MD*

doi: 10.1097/SCS.0000000000002035
Brief Clinical Studies

The natural mandible has 2 arcs, the marginal arc and the occlusal arc. The marginal arc is situated along the lower margin of the mandible and affects the contour of the lower third of the face. The occlusal arc is situated along the dental arc and affects the stability of prosthodontics. The gap between these 2 arcs widens in the molar area. Our developed concept of “double arc reconstruction” involves making these 2 arcs for the reconstructed mandible. For the double-barrel fibula reconstruction, 2 bone segments are used to make both arcs. For reconstructions using the iliac crest, the double arc is made by inclination of the top of the bone graft toward the lingual side. Ten patients underwent double arc reconstruction: 2 underwent reconstruction with the double-barrel fibula, and 8 underwent reconstruction with the iliac crest. Four patients had a removable denture prosthesis, 1 had an osseointegrated dental implant, and 5 did not require further prosthodontic treatment. The shape of the reconstructed mandible after double arc reconstruction resembles the native mandible, and masticatory function is good with the use of a dental implant or removable denture prosthesis, or even without prosthodontics.

*Department of Plastic Surgery

Department of Dentistry, Oral and Maxillofacial Surgery

Department of Otolaryngology, Head and Neck Surgery, Jichi Medical University, Yakushiji, Shimotsuke, Tochigi, Japan.

Address correspondence and reprint requests to Shunji Sarukawa, MD, Department of Plastic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0434, Japan; E-mail:

Received 20 February, 2015

Accepted 28 June, 2015

The authors report no conflicts of interest.

© 2015 by Mutaz B. Habal, MD.