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Placement of a customised load-bearing titanium plate for prevention of iatrogenic mandibular fracture in surgical removal of odontogenic keratocyst recurrence
  1. Andrea Castellani1,
  2. Luca Ferrari1,
  3. Francesco Daleffe1 and
  4. Karim Tewfik2,3
  1. 1Maxillo-facial Unit, ASST Spedali Civili di Brescia, Brescia, Italy
  2. 2Head&Neck Department, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
  3. 3Pediatric Maxillo-facial Unit, ASST Spedali Civili di Brescia, Brescia, Italy
  1. Correspondence to Karim Tewfik; karim.tewfik{at}


A 72-year-old woman with a history of removal of a right hemimandibular keratocyst 10 years ago was referred to our attention for a large swelling of the right cheek. The orthopantomography and the CT scan showed a huge osteolytic area of the right mandibular ramus and angle. The patient’s refusal to resection and reconstruction with a free flap pushed us towards a conservative treatment. The high probability of a iatrogenic mandibular fracture during and after surgery required the design of a customised titanium plate to be preliminary placed through cervical incision along the posterior border of the mandible. The patient successfully underwent the surgical positioning of the customised plate and subsequent removal of the keratocyst. She was discharged fit and well 5 days after surgery. She did not experience any infections, pathological fractures or relapse in the 6-month follow-up.

  • health informatics
  • oral and maxillofacial surgery
  • virtual rehabilitation
  • dentistry and oral medicine

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  • Contributors AC, LF and FD performed the surgical procedure. AC and KT: conception and design, acquisition of data or analysis and interpretation of data. AC, LF, FD and KT: drafting the article or revising it critically for important intellectual content, final approval of the version published, agreement to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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