Modeling of jaw biomechanics in the reconstructed mandibulectomy patient.

STATEMENT OF PROBLEM Biomechanics of occlusal force and indirect calculation of temporomandibular joint loading in patients after surgery for head and neck cancer is poorly understood. PURPOSE This study compared occlusal force values of 6 mandibulectomy subjects with reconstructed mandibles to 6 noncancer subjects with intact mandibles and reports occlusal force predictions from a developed computer model simulation of both a mandibulectomy subject with a reconstructed mandible and noncancer subject with an intact mandible. MATERIAL AND METHODS Maximum occlusal force was recorded at the first molar and incisal edge in 6 mandibulectomy subjects who had bony reconstruction of the mandible and 6 noncancer subjects with an intact mandible. Clinical data were then qualitatively compared with occlusal force values generated from an existing computer model simulating an average adult, and a developed model simulating an average mandibulectomy subject who had bony reconstruction of the mandible. The biomechanical parameters modeled also included an estimation of joint force magnitude and direction when biting with maximal force on the first molar. RESULTS Clinical data revealed no significant differences in occlusal force between the 6 mandibulectomy subjects with bony reconstruction of the mandible and 6 noncancer subjects with an intact mandible; however, average molar and incisal occlusal force values were 22% and 32% less in mandibulectomy subjects with bony reconstruction. Computer simulations of a reconstructed mandibulectomy subject predicted that reconstructed subjects would have 45% less molar occlusal force, 50% less incisal occlusal force, and a higher joint/tooth force ratio compared with a simulated noncancer patient with an intact mandible. CONCLUSIONS There were no significant differences in first molar or incisal occlusal force between reconstructed mandibulectomy subjects and noncancer subjects with intact mandibles. Trends calculated from computer simulations were consistent with clinical findings.