Extensive Mandibular Defects Research Articles

Clinical observation of concentrated growth factor (CGF) combined with iliac cancellous bone and composite bone material graft on postoperative osteogenesis and inflammation in the repair of extensive mandibular defects

PurposeTo evaluate the effects of concentrated growth factor (CGF), combined with a mixture of iliac cancellous and composite bone materials, on the repair of extensive mandibular defects. Patients and MethodsThis clinical trial involved patients with mandibular defects caused by large cystic lesions. The test group comprised 16 patients who underwent CGF combined with iliac cancellous bone and composite bone materials to repair extensive mandibular defects, whereas the control group comprised eight patients who underwent vascularised free fibula grafts for mandibular segmental defects. Postoperative exudatum was collected from patients on the 1st, 2nd, 3rd, and 4th days postoperatively, and osteogenic factor, including alkaline phosphatase (ALP), osteocalcin (BGP), and procollagen type I N-terminal propeptide (PINP), and inflammatory cytokines were performed. Additionally, regular cone beam computed tomography (CBCT) scans were conducted before and after surgery. ResultsOn postoperative days 1–4, the expression levels of ALP, BGP, and PINP were higher in the test group, while those of IL-1α, IL-1β, IL-6, IL-8, and TNF-α, which were identified as co-differentially expressing inflammatory cytokines, were all down-regulated in the exudatum of the test group. Regular CBCT radiological scans revealed a significant osteogenic effect in the test group. ConclusionThe use of CGF combined with iliac cancellous bone and composite bone materials to repair extensive mandibular jaw defects facilitates bone formation and reductions in inflammation in the defect area in the short term, which deserves further research in clinical practice.

Effective oral function improvement by restoration-driven implant treatment after mandibular resection with a scapular flap: a case report

BackgroundThe extensive loss of teeth and surrounding tissues due to mandibulectomy for an oral tumor not only impacts negatively on appearance, but also often causes various functional disorders, decreasing quality of life (QOL). In the present case, reconstruction with a scapular flap was carried out along with segmental mandibulectomy, aiming for functional restoration through restoration-driven implant treatment. A good outcome was obtained, with improvement of masticatory function and QOL following the prosthetic treatment.Case presentationThe patient was a 37-year-old woman diagnosed with ossifying fibroma in the left side of the mandible. Segmental mandibulectomy and reconstruction with a scapular flap were carried out. Implant diagnostic simulation was performed, and based on the result, secondary reconstruction using a particulate cancellous bone and marrow graft was carried out by an oral surgeon. After wound healing was complete, implant placement was performed twice, and the final prosthodontic treatment was completed. Masticatory performance and maximum bite force, which are indices of masticatory function, were improved from before to after prosthetic treatment. In addition, oral health-related QOL was improved from before to after prosthetic treatment.ConclusionIn the present case, restoration-driven implant treatment was performed in a patient following segmental mandibulectomy for a mandibular tumor, with a good outcome. Planning the treatment measures with a focus on the final prosthetic vision can lead to improvement of oral function in patients with extensive mandibular defects.

81. Osteodistraction is viable option for reconstruction of extensive mandibular defects

the treatment of aggresive, extensive odontogenic tuomurs have long been associated with resection and free flap reconstruction. this is to maintain jaw integrity and help future dental rehabilitation. this reconstruction strategy carries morbidity to boney flap donor site, lenghty rehabilitation and lack of bone hieght and superior soft tissue quality. we present a viable option for mandibular reconstruction using intra oral distraction with excellent result.

Extended Total Temporomandibular Joint Replacement - A Feasible Option for Functional and Aesthetic Reconstruction of Mandibular Defects Involving the Temporomandibular Joint.

Study design: Retrospective case series. Objective: Alloplastic temporomandibular joint replacement has been established as a standard technique for end- stage temporomandibular (TMJ) pathologies. Joint replacement when there are extensive mandibular defects remains a challenging clinical problem. Custom-made extended temporomandibular joint replacement is a feasible option but there is limited information about this emerging technique. Methods: Included were all patients undergoing extended TMJ-replacements (TMJe), all operatrions were carried out by the senior author. Surgical technique was either single stage or two stage protocol. Surgical details and pitfalls and outcome of more than 2 years follow-up with reference to thirteen including twelve patients were recorded. Results: The most common diagnosis was ameloblastoma of the mandibular ramus. Single stage or two stagge regime were carried out depending on resection requirements and involvement of teeth. Improved mouth opening of more than 30mm was achieved in 10 of 12 patients. One patient with previous TMJ replacement reported temporary weakness of the facial nerve, which resolved after 10 months. Conclusions: The authors suggest a simplified anatomically based single-stage or two-stage regime, with both regimes achieved excellent anatomic reconstruction, facial appearance and function with low surgical morbidity. Custom-made extended temporomandibular joint protheses appear an advanced and reliable solution for reconstruction of combined complex mandibular defects including the temporomandibular joint. If surgical clearance of the pathology can be achieved, a single-stage regime is favoured.

A case of occlusal reconstruction by dental implant for extensive mandibular defects

A case of occlusal reconstruction by dental implant for extensive mandibular defects

Mandibular reconstruction of the chin area in patients with tumors of the maxillofacial region and oral mucosa

Background. Locally advanced squamous cell carcinoma of the oral cavity invades the mandible in 13–38 % of cases. Even a small segmental resection of the mandible, for instance, in the chin area, causes significant functional and cosmetic impairment and requires immediate reconstruction of the bone defect. Currently available methods of defect closure require a comparative assessment.Materials and methods. This article is based on the outcome data from patients with mandibular tumors treated from 1998 through 2018. We identified 471 cases of mandibular surgery including marginal resection and midline mandibulotomy; 203 (43.1 %) patients underwent segmental resection. Of them, we selected 99 patients with an isolated chin defect combined either with a mandibular body defect or with a subtotal defect in the mandible.Results. In this study, we analyzed the treatment outcomes in patients with primary and secondary mandibular tumors involving the chin as the most difficult for reconstruction from the point of view of the surgeon and the most important for the patient from the functional and aesthetic point of view.Conclusions. A mandibular defect located in the chin area requires immediate reconstruction. The preferable method of defect closure is the application of a reconstruction plate with a musculocutaneous flap or implantation of vascularized bone grafts. Implantation of a fibular free flap is preferable for the closure of extensive mandibular defects involving the chin area.

Reconstruction of extensive mandibular defects involving the temporomandibular joint using alloplastic total joint prosthesis and free tissue transfer

Reconstruction of extensive mandibular defects involving the temporomandibular joint using alloplastic total joint prosthesis and free tissue transfer

Customized reconstruction of an extensive mandibular defect: A clinical report

Myoepithelial carcinomas are rare malignant tumors arising from salivary glands. They most commonly involve the parotid and minor salivary glands but may also occur in the submandibular glands. These tumors can become extensive, causing bony expansion and destruction. A 31-year-old man with a large swelling on the left side of the face is presented. Histologic examination of an incisional biopsy confirmed a diagnosis of a myoepithelial carcinoma arising from the left submandibular salivary gland. After tumor resection, the patient’s mandible was reconstructed with a customized mandibular framework produced by means of 3-dimensional (3D) laser sintering. This approach significantly reduced cost, advanced surgical procedures, and operating room time, which is of great benefit in a developing country like South Africa.

A computer-based comparative quantitative analysis of surgical outcome of mandibular reconstructions with free fibula microvascular flaps

The free fibula osteoseptocutaneous flap is the standard for reconstruction of extensive mandibular defects. The procedure must be precise to achieve the required functional and aesthetic results. The aim of the present study was to calculate retrospectively the exact differences in surgical outcome based on preoperative and postoperative Computed Tomography data sets. Ten patients with unilateral reconstructions of the mandible with a fibula based on conventional planning were analyzed quantitatively, applying mirroring techniques with direct comparison of the theoretically optimum with the actual reconstruction. The results showed that there is a significant discrepancy between what is actually achieved and the theoretical optimum. The result of the present retrospective analysis shows that there is room for further improvement of the outcome in complex mandible reconstruction cases.

Optimal design of an individual endoprosthesis for the reconstruction of extensive mandibular defects with finite element analysis

AimThe aim of this study was to evaluate the finite element analysis (FEA) approach to assess biomechanical performance of individual endoprostheses used in the reconstruction of extensive mandibular defects, and to explore an available strategy for the optimal design of prostheses. Material and methodsA female patient experienced fracture of a titanium mandibular endoprosthesis one year after reconstructive surgery. The endoprosthesis was placed during resection of a mandibular carcinoma. Using CT data, a finite element analysis (FEA) of the implant was performed to identify potential causes for this mechanical failure. Based on the first FEA analysis, modifications of the prosthesis geometry and screw configuration were carried out. FEA was performed for each subsequent modification until no stress concentration areas were identified. The final version of the titanium prosthesis was implanted during the second mandibular reconstruction. ResultsThe FEA model was constructed, based on the geometrical data of the patient. Two areas of stress concentration were identified in the original prosthesis:- at the top surface of the left stem, 1.5 cm away from the corner (the peak stress was 616 MPa) and- on the exterior surface of the right stem, close to the mandibular stump margin.The mechanical failure occurred at the top surface of the left stem. Some common characteristics of the biomechanical performance were noted in the two models, but lower overall stress was achieved in the second, optimized prosthesis. By thickening the recognized high stress areas, and attenuating those areas subject to less stress, then adopting a quadrilateral screw configuration, this dispersed the stress more evenly in the optimized endoprosthesis. Function in the optimized reconstructed mandible was observed for 3 years without significant endoprosthesis related complication. ConclusionIn some patients with extensive mandibular defects, the individually tailored endoprosthesis constructed with regard to minimizing stress concentration using this method seems to have a place. The prosthesis geometry and screw configuration influence the stress–strain distribution on the reconstructed mandible. Our FEA approach can optimize the design of individual endoprostheses and give the reconstructed mandible improved biomechanical performance.

Comparison of reconstruction plate and double flap for reconstruction of an extensive mandibular defect

Functional reconstruction of the anterior mandibular defect in combination with a significant glossectomy is a challenging problem for reconstructive micro-surgeons. In this retrospective study, clinical results were compared between mandibular reconstruction plate (MRP) procedures and double flap transfers. The subjects were 23 patients who underwent immediate reconstruction, after an anterior segmental mandibulectomy in combination with a significant glossectomy, from 1993 to 2009. The patients were divided into two groups based on the reconstructive methods used: MRP and soft tissue free flap transfer (MRP group: 12 patients) or double free flap transfer (double flap group: 11 patients). Operative stress, postoperative complications and oral intake ability were compared between the groups. The rate of recipient-site complication in the double flap group tended to be lower than that in the MRP group. The most frequent complications in the MRP group included infection and orocutaneous fistula. Operative stresses (operation time and blood loss) were significantly less in the MRP group than in the double flap group. Overall, 19 patients (82.6%) were able to tolerate an oral diet without the need for tube feeding. This study demonstrates that laryngeal preservation is possible in more than 80% of patients even after such an extensive ablation. Double flap transfer provides a more stable wound closure than MRP and should be the preferred reconstructive procedure if the patients can tolerate the associated operative stresses.

Customized Bifocal and Trifocal Transport Distraction Osteogenesis Device for Extensive Mandibular Reconstruction

The objective of this study was to report the use of custom-made transport distraction osteogenesis (TPDO) in reconstruction of extensive mandibular defect. Two consecutive patients with mandibular defect involving the body and symphysis were described. Presurgical three-dimensional computed tomography and rapid prototype model were used to design the customized distractor. A bifocal TPDO was performed as immediate reconstruction after mandibulectomy. The trifocal TPDO was carried out 2 years after partial mandibulectomy as a secondary procedure. Postoperatively, patients were followed up with clinical examinations and radiographs. The distractors were removed at the end of 8 months of consolidation period. Both distractors were tolerated well. Both patients had achieved soft- and hard-tissue formation. A mild infection and unexpected unilateral coronoid fracture was noted in one of the patients. However, no functional disturbance to the distractor and no adverse impact on the final result were noted. The use of custom-made TPDO distractor can recreate the mandibular contour in single-stage surgery and avoid the donor-site morbidity. It is a potentially valid method for extensive mandibular defect reconstruction.

Bifocal Distraction to Regenerate Segmental Mandibular Defects Using a Custom Made Device: A Report of Two Cases

Mandibular reconstruction following tumor ablative surgery had been a challenge. It has gone through days of temporary stabilization with k-wire, stainless steel reconstruction plate to avascularized and vascularized bone grafts with varying degree of success and failure. Reconstruction with vascularized bone grafts, though most definitive, requires special expertise, expensive equipment, and long operative time. It also produces donor site morbidity and requires a significant learning curve. With the development of transport distraction techniques there has been a paradigm shift from "reconstructive" to "regenerative" surgery. The objective of this study was to identify the feasibility of an internal device for reconstruction of extensive mandibular defects. This article is to highlight a process of attempted mandibular regeneration in two cases using an indigenously designed distractor device. In individuals with extensive post ablative mandibular defects who were unwilling to have a secondary surgical site or were medically unfit for a long reconstructive procedure, the distraction technique can be used to reconstruct the lost mandibular structures. A satisfactory amount of regenerate was achieved using a bifocal distraction osteogenesis technique for extensive defects of the mandible. The custom made device which was used for this purpose was moderately satisfactory and requires further evaluation and refinement.

The role of distraction osteogenesis in mandibular reconstruction

Distraction osteogenesis is finding increasing application in the management of mandibular defects. It provides an alternative method of mandibular reconstruction in varied clinical settings, notably following trauma and ablation of malignant tumors. Many recent studies have explored modifications in surgical technique, refinements in device design, and experiments in animal models. This review attempts to discuss all of the above. In addition to managing the segmental mandibular gap, the vertical distraction technique is highly useful for increasing fibular bony height, allowing osseointegrated implant placement and dental rehabilitation. Variations in distraction planes, parameters and device placement have made it possible to tailor appropriate reconstructive strategies to the specific patient. Newer developments in distractor design and constituents, and the application of staged distraction procedures, have facilitated optimal management of the challenging defect. Distraction osteogenesis is a continually evolving field of research and study, and an aesthetically and functionally acceptable option for managing extensive mandibular defects, and those not amenable to conventional methods. It offers distinct advantages over other available reconstructive options, but does have its disadvantages. With further improvement in devices and technique, it has the potential of being much more widely used in the future.

Revascularized iliac bone graft for mandibular reconstruction.

Revascularized iliac bone has advantages over other revascularized bone grafts for the reconstruction of large mandibular defects. This is a detailed anatomical study of the blood supply to the iliac bone using microfil and Batson injection methods. It confirms and extends Taylor's study. Clinical results are reported for six cases of extensive mandibular defects which were reconstructed using this method.

Use of surface-decalcified allogenic bone and autogenous marrow in extensive mandibular defects

Use of surface-decalcified allogenic bone and autogenous marrow in extensive mandibular defects