Reconstruction with an individualized titanium mesh cage following wide excision of a mandibular tumor under an intraoperative navigation system: A case series

Abstract

Mandibular reconstruction for wide defects remains a challenge. Although vascularized free flaps are the gold standard for wide defects due to excision of mandibular neoplasms, a less invasive, more aesthetic treatment modality should be considered, especially for benign tumors of young patients. Five patients who received a custom-made titanium mesh cage for transplantation of autologous iliac particulate cancellous bone and marrow for the reconstruction of wide mandibular defects due to ameloblastoma were evaluated. Titanium mesh cage was preoperatively customized and prepared by patient-specific modeling for each case. The segmental resection of mandible for each cases was planned by preoperative computer simulation, and precisely performed with intraoperative surgical navigation systems. Thus, customized titanium mesh cage was perfect fit for all cases. All cases were followed-up for at least 1 year. Two patients had a small fistula because of bacterial infection 1 week after surgery. There was no titanium mesh exposure in the fistula, and local irrigation for several days healed it. Although one patient had a small fracture of the titanium mesh cage 6 months after the surgery, mandibular bone continuity was maintained. A viable, less invasive, more aesthetic alternative to the standard bony reconstructive strategy for wide mandibular defects was described. Further studies to modify the mesh cage design for better outcomes and reconsideration of the materials inducing and replacing the new bone are needed.