case_images: PMC3578664_01
case_images: Imaging of the patient's mandibular defect pre-surgically. (a) Radiolocal image of patient's jaw. (b) CT scan of head
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case_images: PMC3578664_01_rjs02801.jpg
case_images: RJS028F1
case_images: Scans show that the superior margin of the resection is well corticated under the inferior dental nerve (Fig. 1a and b).
case_images: Image of patient's oral cavity during insertion of Osmed pellets. (a) Incisions made in the submucosa. (b) Guides used to size the tunnel for the Osmed pellets. (c) Osmed pellets before insertion into the submucosa
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case_images: PMC3578664_01_rjs02802.jpg
case_images: RJS028F2
case_images: The first step was achieving significant tissue expansion (>2 cm) using Osmed pellets, guided into the submucosa and kept over the alveolar ridge for several months (Fig. 2a-c). 
case_images: Submucosa after adequate tissue expansion. (a) Opening of submucosa to reveal Osmed pellets. (b) Size of Osmed pellets
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case_images: PMC3578664_01_rjs02803.jpg
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case_images: The Osmed pellets were removed from the subperiosteum (Fig. 3a and b) and the iliac bone graft was taken, made up of cortical and cancellous bone and placed to one side (Fig. 4a-c).
case_images: Titanium construct packed with iliac bone graft and screwed into position on the lower mandible
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case_images: PMC3578664_01_rjs02805.jpg
case_images: RJS028F5
case_images: Once fitted to the patients jaw, it was packed with the bone graft and screwed down into position (Fig. 5).
case_images: Image of patient's surgical site. (a) Tissue expanded submucosa is sutured close. (b) Buccal mucosa is sutured close. (c) Image of post-surgical site
case_images: rjs02806.jpg
case_images: PMC3578664_01_rjs02806.jpg
case_images: RJS028F6
case_images: To complete the surgery, the periosteum was sutured over the construct and then the buccal muscosa was sutured over again to form a double-layered closure (Fig. 6a-c).The purpose of this was to prevent infection and rejection, by ensuring that there was an increased distance between the foreign object (titanium construct) and the outside environment.