Sacrifice of the inferior alveolar nerve (IAN) during resection of the mandible is taken as a rule. In 1987, Jensen and Nock described a technique that permitted placement of dental implants in the atrophied mandibular alveolar ridge that lacked sufficient vertical height superior to the mandibular canal. This technique was used by some authors to preserve continuity of the IAN during resection of the mandible in patients with benign tumors. The described techniques are traumatic, time-consuming, and not precise. We propose a new refined technique of preservation of IAN with use of a guide to approach mandibular canal, cutting guides with a slot for a relocated IAN, and a new approach to positioning of the fixating screws. We assessed the effectiveness of this new technique with use of an electro-odontometer. In 21 cases, we demonstrated a refined approach to preservation of the IAN. In 7 patients (33%), the IAN was preserved on one side and in 14 patients (67%), on both sides. Sensation in the lower lip was restored in 18 patients (86%). These patients generally recovered sensation within 22 days postoperatively. This proposed technique makes preservation of IAN easier, faster, less traumatic, and more predictable. In this article, we describe criteria for the patients with cancer of oral mucosa to be admitted for this procedure. Restored sensation in the lower lip of the patients who have undergone resection of the mandible significantly improves their quality of life.

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Efficient Combat Casualty Care System aims at saving lives of the wounded as well as regaining their quality of life at the highest possible level. This article provides the data on using revascularized grafts to repair gunshot defects, presents data on the proportion, cause, severity and nature of facial wounds. We also give here recommendations on treatment modalities in these patients. In between the 1 March and the 1 November 2022 in the Center of maxillofacial surgery and dentistry of Main Military Hospital named after N.N. Burdenko we performed 54 reconstructions, 47 of which were microvascular utilizing 49 free flaps. Despite good vasculature in the face, it lacks soft tissues for closing vast gunshot defects. Damaged with high energy projectiles the tissue of the face gives poor bedding to the alloplastic implants, resulting in their exposure. Contemporary level of microvascular technique gives the plastic surgeon an efficient instrument for closing the gunshot defects in early wound healing period. We do not recommend using regional tissues to treat gunshot defects in the first place, because they are usually insufficient to fully resolve the defect, and at the same time it leads to a violation of the anatomy and even greater deformation of the soft tissues surrounding the defect. Titanium re constructive and mesh plates are associated with high rate of exposure in the bone defects and are not to be recommended for the reconstruction either.

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