Cancellous Marrow Research Articles

How Much Pain Medication Do Patients Require After Posterior Iliac Crest Bone Graft to the Alveolar Cleft?

The purpose of this study was to quantify analgesic use following alveolar cleft bone grafting (ABG) utilizing a posterior iliac crest (PIC) donor site. This is a prospective cohort study of consecutive patients that underwent ABG with PIC in a 10 month period from November 2022 to September 2023. Tertiary care free-standing pediatric hospital. Patients with cleft lip and alveolus with or without cleft of the secondary palate undergoing alveolar bone graft with cancellous marrow from the PIC. All patients underwent ABG and recorded analgesic use afterwards. The main outcome variable was total pain medication utilization during the first 10 postoperative days (PODs). 22 subjects (72.7% male, 54.5% Caucasian 72.7% unilateral and 27.3% bilateral clefts) recorded pain medication use. Total duration of analgesic use (any type) was 3.86 ± 1.7 postoperative days. 10 subjects (45.5%) did not use opioid medication postoperatively. The remaining 12 subjects (54.5%) used a median of 12 (0, 19) morphine milli-equivalents (MME), equal to 1.6 (0, 2.53) doses of 5 mg oxycodone. An average of 9.9 ± 5.6 doses of acetaminophen and 9.1 ± 4.7 doses of a non-steroidal anti-inflammatory drug (NSAID) were administered. No subject used opioids after POD3. Patients with unilateral clefts used more acetaminophen (p = 0.02); otherwise, there were no significant differences in outcomes based on any predictor variable (p > 0.05). Analgesic requirements after ABG with PIC were minimal, with nearly half of patients taking no postoperative opioids. As such, judicious opioid prescribing is prudent. .

Maxillary reconstruction using tunneling flap technique with 3D custom-made titanium mesh plate and particulate cancellous bone and marrow graft: a case report

BackgroundReconstructive surgery is often required for tumors of the oral and maxillofacial region, irrespective of whether they are benign or malignant, the area involved, and the tumor size. Recently, three-dimensional (3D) models are increasingly used in reconstructive surgery. However, these models have rarely been adapted for the fabrication of custom-made reconstruction materials. In this report, we present a case of maxillary reconstruction using a laboratory-engineered, custom-made mesh plate from a 3D model.Case presentationThe patient was a 56-year-old female, who had undergone maxillary resection in 2011 for intraoral squamous cell carcinoma that presented as a swelling of the anterior maxillary gingiva. Five years later, there was no recurrence of the malignant tumor and a maxillary reconstruction was planned. Computed tomography (CT) revealed a large bony defect in the dental-alveolar area of the anterior maxilla. Using the CT data, a 3D model of the maxilla was prepared, and the site of reconstruction determined. A custom-made mesh plate was fabricated using the 3D model (Okada Medical Supply, Tokyo, Japan). We performed the reconstruction using the custom-made titanium mesh plate and the particulate cancellous bone and marrow graft from her iliac bone. We employed the tunneling flap technique without alveolar crest incision, to prevent surgical wound dehiscence, mesh exposure, and alveolar bone loss. Ten months later, three dental implants were inserted in the graft. Before the final crown setting, we performed a gingivoplasty with palate mucosal graft. The patient has expressed total satisfaction with both the functional and esthetic outcomes of the procedure.ConclusionWe have successfully performed a maxillary and dental reconstruction using a custom-made, pre-bent titanium mesh plate.

腸骨PCBM移植術を併用し再手術を行った下顎骨変治骨折の1例

腸骨PCBM移植術を併用し再手術を行った下顎骨変治骨折の1例

Immediate Trans-Oral Tissue Engineered Allogeneic Bone Grafting for Large Continuity Defects. Less Morbidity, More Bone. A Paradigm in Benign Tumor Mandibular Reconstruction?

Reconstruction of hard tissue continuity defects caused by ablative tumor surgery have been traditionally reconstructed with autogenous cancellous marrow grafts or microvascular free flaps. Although results have been predictable from both methods of reconstruction, the morbidity associated with bone harvest is quite significant for the patient. With the advances made in tissue engineering, successful and predictable results has been obtained with using a combination of 100% cadaver bone, Bone Marrow Aspirate Concentrate (BMAC) and rhBMP-2 for immediate reconstruction for benign tumor extirpations via extra-oral approach. In light of these successful outcomes the same combination was evaluated with an intraoral approach. This case study aims to evaluate the success of immediate mandibular reconstruction via intra-oral approach without any autogenous bone harvesting.

Clinical usefulness of mandibular reconstruction using custom-made titanium mesh tray and autogenous particulate cancellous bone and marrow harvested from tibia and/or ilia

The objective of this study was to evaluate usefulness of mandibular reconstructions using custom-made titanium mesh (Ti-mesh) tray and particulate cancellous bone and marrow (PCBM). Consecutive 21 patients who underwent mandibular reconstruction were enrolled in this study. They were 13 men and 8 women (mean age, 52.0 years). Virtual reality simulation was performed using computer software based on the preoperative computed tomography data. A 3-dimensional skull model was constructed using 3-dimensional printer. A tray was custom-made from Ti-mesh sheet bent to adapt to the model. After PCBM harvesting from posterior ilia and/or proximal tibia, the tray was fixed to the host bone. New bone formation and configuration of the reconstructed mandible were assessed radiologically. Complications were recorded in each patient during the follow-up period. Patients' satisfaction with postoperative facial contour was evaluated using visual analog scale (VAS score, range, 0-100). In 16 of 21 patients, excellent new bone formation was recognized and expected results were radiologically achieved. In 5 patients, new bone formation was insufficient. Causes of insufficient bone formation included postoperative infection in 2 patients, Ti-mesh tray fracture in 2 patients, and local recurrence of lower gingival cancer in 1 patient. To prevent a tray fracture, a double-layered Ti-mesh tray was useful. Mean VAS score on patients' satisfaction was 77.1. Our results comprehensively suggest that mandibular reconstruction using custom-made Ti-mesh tray and PCBM is clinically useful.

Ultrasound–Guided Surgery of Particulate Cancellous Bone and Marrow from the Iliac Crest for Cleft Palate

Minimally invasive procedures for treatment of disease have become increasingly popular and require specialized instruments and precise imaging guidance. We here propose a technique of minimally invasive surgery with ultrasound echo-guided procedures as a less traumatic and invasive procedure to get particulate cancellous bone and marrow from the iliac crest for cleft palate. This technique has been used successfully at our institutions. Our experience suggests that it can provide reliable ultrasound echo imaging-guided surgery.

The Utilization of Allogeneic Bone, Bone Morphogenetic Protein and Bone Marrow Aspirate Concentrate for Immediate Reconstruction of Benign Tumor continuity defects

Reconstruction of hard tissue continuity de- fects caused by ablative tumor surgery has been tradition- ally reconstructed with autogenous cancellous marrow grafts or microvascular free flaps. Although results have been predictable from both methods of reconstruction, the morbidity associated with bone harvest is quite signif- icant for the patient. With the advances made in tissue en- gineering,itisouropinionthatsuccessfulandpredictable results can be obtained with using a combination of 100% cadaver bone, Bone Marrow Aspirate Concentrate (BMAC) and rhBMP in immediate reconstruction for benign tumor extirpations. Material and Methods: The aim of this retrospective study is to share our experience with the use of 100% allo- geneicboneincombinationwithBMPandBMACforimme- diate reconstruction of continuity defects resulted from benigntumorsurgery.Thepresentstudyreviewedpatients

Twenty-year follow-up of reconstruction with allogeneic hemimandible and autogenous particulate bone and cancellous marrow

This report shows a long-term follow-up of a mandibular reconstruction with a composite graft, consisting of an allogeneic bone crib packed with autogenous particulate bone and cancellous marrow (PBCM). In this patient, segmental mandibulectomy including exarticulation of the temporomandibular joint (TMJ) had been necessary, due to recurrent odontogenic myxoma including the TMJ. Reconstruction was performed with an allogeneic freeze-dried hemimandible with TMJ, packed with compressed autogenous PBCM. Oral rehabilitation was completed with a fixed bridge on two dental implants in the distal part of the graft. During the early follow-up, osteolysis at the mandibular angle and gradual resorption of the temporomandibular joint was observed. Long-term follow-up revealed stable incorporation of the graft with consolidation of defects. A class I occlusion and uninhibited maximum mouth opening remained present. Twenty years after reconstruction with the composite graft, the patient is very satisfied, with high functional success. This implies the composite graft can be a successful treatment option in specific cases of mandibular reconstruction.

カスタムメイド・チタンメッシュトレーと自家腸骨／脛骨海綿骨骨髄細片による下顎骨再建の臨床的有用性（原著）

カスタムメイド・チタンメッシュトレーと自家腸骨／脛骨海綿骨骨髄細片による下顎骨再建の臨床的有用性（原著）

Mandibular reconstruction using custom-made titanium mesh tray and particulate cancellous bone and marrow harvested from bilateral posterior ilia

The objective of this study is to evaluate usefulness of mandibular reconstructions using a custom-made titanium mesh (Ti-mesh) tray and particulate cancellous bone and marrow (PCBM). A consecutive nine patients who underwent mandibular reconstruction were enrolled in this study. They were five men and four women (mean age: 53.9 years). Virtual reality simulation was performed using computer software based on the pre-operative computed tomography data. A 3-dimensional (3-D) skull model was constructed using a 3-D printer. A tray was custom-made from a Ti-mesh sheet bent to adapt to the model. After PCBM harvesting from bilateral posterior ilia, the tray was fixed to the host bone. New bone formation and configuration of the reconstructed mandible were assessed radiologically. Complications were recorded in each patient during the follow-up period. Patients, satisfaction with post-operative facial contour was evaluated using a visual analogue scale (VAS score, range = 0–100). In six of nine patients, excellent new bone formation was recognised and expected results were radiologically achieved. Complications occurred in four patients. These complications included Ti-mesh fracture, Ti-mesh exposure in the oral cavity, and delayed infection. Mean VAS score on patient satisfaction was 77.6. Although the data are preliminary, the results suggest that this method is clinically useful.

Alveolar cleft closure with reinforcement from cyanoacrylate to the mucosal closure and cortical strut interposition in 28 patients and evaluation by CBCT

Methods: In our proposed technique of nasoalveolar cleft repair, nasal and oral mucosal flaps are elevated. Once nasal mucosa is sutured, cyanoacrylate is applied to nasalflap. Nose is irrigated to ensure a water-tight closure. Next, corticalstrut from iliac crest or allogeneic sheet is positioned by friction adaptation. Particulate cancellous marrow or BMP allogenic particulate mixture is compacted. Following advancement and flaps suturing, cyanoacrylate is applied to oral closure. We obtain presurgical Conebeam computed tomography (CBCT), which is compared to 6 months post-surgical study with assessment of grayscale Hounsfeld Units (HU).

カスタムメイド・チタンメッシュトレーと自家海綿骨骨髄細片を用いた下顎骨再建

本論文では，著者らが行っているカスタムメイド・チタンメッシュトレーと自家海綿骨骨髄細片を用いた下顎骨再建術を代表症例を提示しながら紹介する。このチタンメッシュトレーは下顎骨欠損部に正確に適合し，CAD/CAMと歯科技工の技術を駆使することで，個々の患者の最終的な咬合回復に適した外形を備えている。本法を用いて11人の下顎骨欠損患者（9人の区域欠損と2人の辺縁欠損）の下顎を再建した。再建手術は全例とも支障無く終了し，術後の患者の顔貌もほとんどの症例で整容的に十分許容できるものであった。11例中2例のオトガイ部を含む欠損例で術後3ヶ月以内のチタンメッシュトレーの破折を経験したが，海綿骨骨髄細片と補強型チタンメッシュトレーを適用して再手術を行ったところ良好な結果が得られている。以上より本法には若干の改良の余地が残されているものの，従来の再建方法に比べると臨床的により予知性の高い方法であると思われた。

Application of Regenerative Medicine to Mandibular Reconstruction

Among the various methods of mandibular reconstruction, regeneration using poly-L-lactic acid mesh and particulate cancellous bone and marrow attained good efficacy and safety in a multi-institution prospective clinical study in Japan (Project No. GM941). This mandibular reconstruction method is not difficult to perform and is minimally invasive to the patient. If the use of this surgical technique spreads worldwide, elimination of disparities among medical treatment outcomes is expected.

RhBMP-2/ACS Grafts Versus Autogenous Cancellous Marrow Grafts in Large Vertical Defects of the Maxilla: An Unsponsored Randomized Open-Label Clinical Trial

This study compared the histologic parameters and outcomes of two types of grafts in large vertical maxillary defects: a composite graft of recombinant human bone morphogenetic protein-2/acellular collagen sponge (rhBMP-2/ACS), crushed cancellous freeze-dried allogeneic bone (CCFDAB), and platelet-rich plasma (PRP); and size-matched 100% autogenous grafts. Twenty patients each were treated with a composite graft, which contained 1.05 mg rhBMP-2/ACS per two-tooth segment together with CCFDAB and PRP, or a 100% autogenous graft prior to implant placement. Grafting material was contained within a titanium mesh crib. Two grafts in each group were lost as a result of early mesh exposure and infection. Three grafts in each group developed a late exposure of the mesh that did not affect bone regeneration. The remaining 18 autogenous grafts all regenerated sufficient bone for implant restoration (100%), and 17 of 18 (97.4%) of the composite grafts regenerated sufficient bone for implant restoration. The autogenous grafts included 54% ± 10% of new viable bone but also included residual nonviable graft particles. The composite grafts contained 59% ± 12% viable new bone and no remaining nonviable bone particles. The composite grafting technique resulted in less blood loss and shorter surgical time but greater and longer-lasting edema. The costs of both grafts were nearly equal. A composite graft of rhBMP-2/ACS-CCFDAB-PRP regenerates bone in large vertical ridge augmentations as predictably as 100% autogenous graft with less morbidity, equal cost, and more viable new bone formation without residual nonviable bone particles, but with more edema. This composite graft represents an in situ tissue engineering concept that is able to achieve results equivalent to autogenous grafts in large vertical ridge augmentations without donor bone harvesting.

Influence of Mandibular Reconstruction on Patients' Health-Related Quality of Life

To evaluate and compare the influence of different types of mandibular reconstruction on health-related quality of life (HR-QoL) of nonrecurrence patients. We recruited 252 patients who underwent mandibular reconstruction between 1994 and 2007 for this cross-sectional study. They were classified into groups based on reconstruction technique: free bone graft (FBG) group, particulate bone cancellous marrow graft (PBCMG) group, reconstruction plate (RP) group, and microvascular free flap group. The University of Washington Head and Neck Quality of Life Questionnaire and 5 supplemental domains regarding the donor sites were used to evaluate and compare HR-QoL among the groups. The outcomes of the University of Washington Head and Neck Quality of Life Questionnaire differed significantly among the groups (P < .0001). The results of the additional donor site domains also differed greatly among the groups (P < .0001). Appearance, chewing, activity, appearance-donor site, and function-donor site were the domains that were most frequently chosen by the patients as the most important issues. Most of the patients rated their HR-QoL as somewhat better compared with their experience the month before they underwent reconstruction. The HR-QoL and overall quality of life (QoL) during the past 7 days were rated as very good in the FBG group and PBCMG group and good in the RP group and microvascular free flap group. HR-QoL of patients in the FBG and PBCMG groups did not differ significantly with regard to any of the domains, and these 2 groups consistently had the highest mean scores. Both groups differed significantly from the RP group, which tended to report the lowest mean scores for the domains.

Spatial gradients of blood vessels and hematopoietic stem and progenitor cells within the marrow cavities of the human skeleton

AbstractThis report evaluates the spatial profile of blood vessel fragments (BVFs) and CD34+ and CD117+ hematopoietic stem and progenitor cells (HSPCs) in human cancellous bone. Bone specimens were sectioned, immunostained (anti-CD34 and anti-CD117), and digitally imaged. Immunoreactive cells and vessels were then optically and morphometrically identified and labeled on the corresponding digital image. The distance of each BVF, or CD34+ or CD117+ HSPC to the nearest trabecular surface was measured and binned in 50-μm increments. The relative concentration of HSPCs and BVFs within cancellous marrow was observed to diminish with increasing distance in the marrow space. On average, 50% of the CD34+ HSPC population, 60% of the CD117+ HSPC population, and 72% of the BVFs were found within 100 μm of the bone surfaces. HSPCs were also found to exist in close proximity to BVFs, which supports the notion of a shared HSPC and vessel spatial niche.

Study of ameloblastoma: 102 cases

Background and Objectives: Ameloblastoma is a benign but invasive odontogenic tumour, grows slowly and persistently. The tumour spreads into the cancellous marrow spaces, without concomitant resorption of the trabecular bone. It is considered to be locally invasive and recurs frequently after surgical procedures. Ameloblastoma of the unilocular type are said to have a better clinical course than are those of the multilocular type. Various type of treatment were done like conservative surgical approach to radical resection of the jaws, depending upon the age, site, radiological and histological type of tumours.

Reconstruction of Defects Caused by Bisphosphonate-Induced Osteonecrosis of the Jaws

Reconstructive surgery of defects for any disease or injury including bisphosphonate-induced osteonecrosis of the jaws requires an understanding of the pathophysiology of the condition. Related to bisphosphonates, it is the apoptosis (programmed cell death) of the osteoclast that inhibits, and in some cases stops, bone renewal/remodeling altogether. Therefore, reconstruction begins with a debridement of resection considering this mechanism. For intravenous bisphosphonate-induced osteonecrosis defects of the mandible, most resections are immediately reconstructed with a rigid titanium plate provided that secondary infection is controlled, there is sufficient soft tissue present, and a resection margin containing variable bone marrow can be achieved. For some similar defects with significant secondary infection, a delayed rigid plate placement after the recipient site has healed and is infection free represents another option. In those defects in which there is a significant soft tissue loss, flap reconstruction may also be necessary. The pectoralis major myocutaneous flap is the most predictable and most commonly used flap, followed by the trapezius myocutaneous flap, and stemocleidomastoid flap. Bone graft reconstructions are rarely needed, and are often not indicated due to minimal benefit for the patient, anesthetic risks, or active cancer at metastatic sites. However, in selected cases, mostly for breast cancer or prostate cancer patients with continuity defects from intravenous bisphosphonate-induced osteonecrosis, standard cancellous marrow grafting with platelet-rich plasma growth factor supplementation has been successful. Maxillary resections are treated with prosthodontic obturators as they are in primary cancer surgery. Reconstruction of oral bisphosphonate-induced osteonecrosis defects usually takes the form of alveolar grafting and/or dental implant placements, and only rarely requires grafting of continuity defects. Standard grafting techniques and dental implant placements can be used if guided by the published serum C-terminal telopeptide (CTX) test. The guidelines are less than 100 pg/mL = high risk, 100 pg/mL to 150 mg/mL = moderate risk, and greater than 150 pg/mL = minimal risk.

チタンメッシュトレーと自家腸骨海綿骨細片による顎骨・顎堤再建

チタンメッシュトレーと自家腸骨海綿骨細片による顎骨・顎堤再建

Clinical application of bone regeneration by in vivo tissue engineering

With regard to the graft materials, cortical bone block, vascularized bone flap and particulate cancellous bone and marrow (PCBM) have been used for the reconstruction of maxillofacial skeleton. Needless to say, the aim of cortical bone block and vascularized bone flap transfer is the transplantation of bony tissue of its own. On the other hand, the main objective of PCBM grafting is the transplant of osteogenic stem cells derived from uncommitted marrow mesenchymal cells. After PCBM grafting, active new bone formation occurs from osteogenic stem cells followed by bone remodeling and replacement of host bone. This process means that PCBM grafting is the method of bone regeneration that is based on in vivo tissue engineering. In this paper, clinical application of PCBM grafting for the reconstruction of maxillofacial skeleton is introduced by showing the repair of maxillary bony defect of cleft lip and palate patients, alveolar ridge augmentation and the reconstruction of large mandibular segmental defects.