Titanium Reconstruction Plate Research Articles

Mandible Reconstruction with 3D Virtual Planning

The fibula free flap has now become the most reliable and frequently used option for mandible reconstruction. Recently, three dimensional images and printing technologies are applied to mandibular reconstruction. We introduce our recent experience of mandibular reconstruction using three dimensionally planned fibula free flap in a patient with gunshot injury. The defect was virtually reconstructed with three-dimensional image. Because bone fragments are dislocated from original position, relocation was necessary. Fragments are virtually relocated to original position using mirror image of unaffected right side of the mandible. A medical rapid prototyping (MRP) model and cutting guide was made with 3D printer. Titanium reconstruction plate was adapted to the MRP model manually. 7 cm-sized fibula bone flap was designed on left lower leg. After dissection, proximal and distal margin of fibula flap was osteotomized by using three dimensional cutting guide. Segmentation was also done as planned. The fibula bone flap was attached to the inner side of the prebent reconstruction plate and fixed with screws. Postoperative evaluation was done by comparison between preoperative planning and surgical outcome. Although dislocated condyle is still not in ideal position, we can see that reconstruction was done as planned.

Mandibulectomies made easier – a simple drill guide

Mandibular reconstruction following oncological resections poses many challenges for the maxillofacial surgeon. The use of customised pre-bent titanium reconstruction plates based on sterolithographic models has proven to be a significant step forward in the reconstruction of these defects. If all buccal soft tissue can be stripped from the section of mandible planned for resection, the pre-bent titanium plate can be applied to the mandible, prior to osteotomies being performed, and the holes for screw fixation can be drilled either side of the planned osteotomies, i.e. the pre-bent plate is used as the guide for drilling the holes.

Primary intraosseous squamous cell carcinoma in pre-existing keratocystic odontogenic tumor: A case report and literature review.

Primary intraosseous squamous cell carcinoma (PIOSCC) is a rare type of odontogenic carcinoma that arises within the jaws. PIOSCC has no initial connection with oral mucosa and possibly develops from the residues of the odontogenic epithelium or from an odontogenic cyst or tumor. The diagnosis of PIOSCC can be difficult as it must be differentiated from other odontogenic carcinomas, such as malignant ameloblastoma, from SCCs arising from the overlying oral mucosa, from the primary tumors of the maxillary sinus or nasal mucosa, and from the tumors that have metastasized to the jaws from other primary sites. The present study reported a rare case of a 59-year-old male patient with a course of keratocystic odontogenic tumor for 25 years, between 1988 and 2013, which eventually transformed into PIOSCC after at least five recurrences and corresponding treatments. The mandible excision and titanium plate reconstruction was performed. Follow-up examinations have revealed no sign of recurrence thus far. The present study discussed this case from three aspects of clinical history, radiological examination and pathological features.

Innovative Approach for Interim Facial Prosthesis Using Digital Technology.

Despite the important role of facial prosthetic treatment in the rehabilitation of head and neck cancer patients, delay in its implementation can be unavoidable, preventing patients from receiving a prompt facial prosthesis and resuming a normal social life. Here, we introduce an innovative method for the fabrication of an interim facial prosthesis. Using a 3D modeling system, we simplified the fabrication method and used a titanium reconstruction plate for facial prosthesis retention. The patient received the facial prosthesis immediately after surgery and resumed a normal social life earlier than is typically observed with conventional facial prosthetic treatment.

A Case of Traumatic Flail Chest Requiring Stabilization with Surgical Reconstruction.

Background Flail chest is the most serious complication that may occur after thoracic trauma. In this article, we present a case of flail chest caused by blunt chest trauma, which presented dramatic clinical improvement following rib fixation and chest wall reconstruction. Case Description A 53-year-old male patient with flail chest because of the trauma who had been followed in intensive care unit for mechanical ventilatory support underwent chest wall stabilization with titanium reconstruction plate and screws. Conclusion The main objective is surgical stabilization of the chest wall in cases of flail chest with a parenchymal damage because of the severe rib fracture, which need prolonged mechanical ventilation.

Application of titanium plate reconstruction in laminoplasty during the thoracolumbar burst fractures

Objective To investigate the application value of using reconstruction of the posterior wall of vertebral canal with titantium plate and bone grafting in the thoracolumbar burst fracture surgery. Methods Twenty-seven patients with thoracolumbar burst fracture with spinal cord injury were treated with posterior pedicle screw fixation+ holo-laminectomy+ titanium plate bending for reconstruction of posterior expansive laminoplasty, and the depressurized lamina process was trimmed into bone grains and were mixed with allogeneic bone for bone grafting along the titanium plate surface. The kyphotic Cobb angle, bone graft fusion, and neurological recovery were of the patients were assessed after procedure. Results The postoperative CT and MRI findings in 27 patients suggested that the vertebral canal volume recovered well, the spinal cord compression relieve was satisfactory. The neurological function of 16 patients was improved during the hospitalization. All patients were followed up after discharge. They were followed up for 12 to 30 months (mean 17.8 months). Their final neurological function was improved in 21 patients compare with before procedure (ASIA grade: type A 3 cases, type B 6 cases, type C 8 cases, and type D 10 cases), and 14 of them recovered completely, 7 recovered partially, and 6 did not have any changes (ASIA grade: type A 3 cases, type B 3 cases, type C 3 cases, type D 4 cases, and type E 14 cases). The function improvement rate of the patients was 78% (21/27) after procedure. No symptoms of delayed spinal cord compression were observed during the follow up period. The internal fixation screw rods of 9 patients were removed from 13 to 21 months after procedure because of their personal reasons, but the forming titantium plates were reserved. All patients did not have the phenomena including increased kyphosis angle, titantium plate shift, deformation, and decreased vertebral canal volume. The bone grafting fusion rate was 100%. No spine instability was observed. There was no significant differences in the lost degrees of kyphosis angle and the height change ratio of the injured vertebrae (P>0.05). Conclusions Using titanium plate for laminoplasty and bone grafting are simple, safe and reliable after surgical reduction decompression and fixation in the treatment of thoracolumbar burst fractures with spinal cord injury. It is conducive to maintaining the integrity and stability of spines. The recovery of spinal cord function is satisfactory. Key words: Titanium plate; Thoracolumbar fracture; Fracture

Diagnostic Features and Management Strategy of a Refractory Case of Osteoradionecrosis of the Mandible - A Case Report

Introduction: Osteoradionecrosis of the jaws produces a considerable amount of esthetic as well as functional deficits, seriously affecting quality of life of the patient. Cases are often notoriously difficult to treat and manage owing to associated comorbidities of the patient, post irradiation fibrosis and decreased vascularity at the site, which complicates free tissue flap and graft transfer, that subsequently succumb to failure. Hyperbaric Oxygen Therapy (HBOT), in which 100% Oxygen is administered by mask under 2.4 Atm pressure, in a Hyperbaric oxygen chamber, helps by increasing local vascularity. Aim and methods: It was the aim of this study to show that a particularly refractory, compromised and challenging case of osteoradionecrosis can be managed successfully even without HBOT, by mandibular segmental resection followed by reconstruction using a titanium reconstruction plate enveloped within a pedicled Pectoralis Major Myocutaneous flap. Result: Post-operative recovery of the patient was excellent with good functional and esthetic rehabilitation of the patient with and practically nil donor site morbidity. Conclusion: It is important to have a thorough knowledge of the clinical, radiographic, histopathologic, CT and MRI features of osteoradionecrosis of the jaws in order to make a quick and accurate confirmatory diagnosis and to overcome possible diagnostic dilemmas.The strategy of reconstruction of a large mandibular defect using a bridging titanium plate sandwiched by a healthy vascularized myocutaneous flap, following ablative surgery for ORN, has proved to be a safe and reliable option for composite mandibular defects, with gratifying long term functional and cosmetic results.

Ameloblastic carcinoma of the mandible: A case report

Introduction: Ameloblastic carcinoma is an extremely rare, malignant epithelial tumor of the jaws with a poor prognosis. the most common site of occurrence is the posterior mandible. clinically, it is very aggressive and has potential for extensive local destruction. Majority of the cases arise de novo (primary type), but a few cases arise from a pre-existing ameloblastoma (secondary type). case report: A 30-year-old female presented with a chief complaint of swelling on the left side of the face for the past one year. An incisional biopsy was performed and the histopathology was consistent of ameloblastic carcinoma. On the basis of the histopathology report, left hemimandibulectomy was done taking a safe margin of 2 cm and the defect was reconstructed using titanium reconstruction plate. chemotherapy and radiotherapy were not advised. the patient is under regular follow-up. No recurrence nor metastases reported during the follow-up period. conclusion: Early diagnosis and wide local excision on the primary site is the treatment of choice. the risk of malignant transformation should always be considered when a classic ameloblastoma is diagnosed and the prompt definitive management of an ameloblastoma is essential to eliminate this risk. Finally, meticulous, long-term follow-up is mandatory because recurrence and metastasis in the lung and regional lymph nodes have been reported.

Surgical planning and microvascular reconstruction of the mandible with a fibular flap using computer-aided design, rapid prototype modelling, and precontoured titanium reconstruction plates: a prospective study

The standard of mandibular reconstruction has increased since the introduction of computer-assisted design (CAD) and rapid prototype modelling (RPM) for surgical planning.Between 2008 and 2013, a prospective pilot study of 20 patients was planned to compare the outcomes of patients treated by mandibular reconstruction who had CAD and RPM-guided operations using a precontoured titanium plate, with the outcomes of patients treated conventionally. We recorded the time taken for reconstruction, total operating time, and whether this type of planning could improve the results of mandibular reconstruction. We found significant differences in the incidence of dental malocclusion (p=0.03) and exposure of the titanium plate (p=0.009). The mean operating time for reconstruction in the preoperative planning group was 135 (37)min compared with 176 (58)min in the conventional group (p=0.04).Preoperative planning using CAD and RPM can increase the accuracy of microvascular mandibular reconstruction and reduce the operating time for reconstruction.

Clinical evaluation of computer-assisted surgical technique in the treatment of comminuted mandibular fractures

ObjectiveThe aim of this study is to establish the advantages and efficiency of computer-assisted surgical (CAS) technique in the treatment of comminuted mandibular fractures compared with conventional technique. MethodsIn the CAS group, 12 patients with comminuted mandibular fractures were treated with computer-assisted technique. Before surgery, a virtual reduction surgery was carried out in the software program MIMICS10.01. Then a reconstructed physical mandible was manufactured for preforming the titanium reconstruction plates. Based on the preoperative planning, the real surgery was carried out. Twelve cases with the same type of fracture treated with conventional technique were reviewed as the part of the control group. The clinical outcome of the surgery was evaluated in the two groups. ResultsCompared with the patients in the control group, in the case of 12 patients in the CAS group a decrease in the operation time and the amount of intraoperative bleeding as well as a superior outcome with respect to satisfaction, mandibular symmetry and postoperative level of opening the mouth were achieved. ConclusionThe CAS of preoperative 3-D planning and preformed plates is a clinically feasible tool for surgeons to improve the treatment of comminuted mandibular fractures.

Lateral-rectus approach for treatment of acetabular fracture combined with ipsilateral pelvic fracture

Objective To explore the clinical effect of lateral-rectus approach for the intemal fixation of acetabular fractures with concurrent ipsilateral pelvic fracture.Methods From March 2011 to March 2013,15 patients with acetabular fracture and ipsilateral type C pelvic fracture were surgically managed through the lateral-rectus approach.They were 10 males and 5 females,with an average age of 45.6 years (from 21 to 64 years).According to Judet-Letournel classification,there were 8 anterior column fractures,3 anterior column plus posterior hemitransverse fractures,and 4 double column fractures.All the cases had concurrent pelvic fractures.By Tile classification,there were 5 cases of type B2.1,7 ones of type C1.2,and 3 ones of type C1.3.The duration from injury to surgery ranged from 5 to 21 days,averaging 11 days.Eleven cases of merely anterior acetabular and pelvic fractures were treated with the lateral-rectus approach only,in the supine position.Four cases involving the posterior acetabular wall and posterior column were treated with combined lateral-rectus and posterior Kocher-Langenbeck approaches,in the floating position.The titanium reconstruction plates and cannulated screws were applied in these cases.Results The operation time averaged 105 minutes and the intraoperative blood loss 640 mL.Postoperative X-ray and CT exams showed excellent and good reduction.According to the Matta radiological evaluation postoperatively,reduction of acetabular fracture was rated as anatomic in 8 cases,satisfactory in 4 and unsatisfactory in 3.Injury to the sciatic nerve occurred in one case,and fat liquefaction at the abdominal incision in one case.All the patients were followed up for 10 to 20 months (average,16 months) and the fractures healed after 10 to 15 weeks (average,12 weeks).According to the modified Merle d'Aubigne and Postel scoring system,10 cases were excellent,4 good,and one fair 6 months after operation.Conclusions Surgical management of acetabular fractures through the lateral-rectus approach can provide adequate exposure for not only the treatment of acetabular fractures involving the anterior column and the quadrilateral surface,but also the simultaneous treatment of ipsilateral fractures involving the pubic superior ramus,iliac ala and sacroiliac joint,leading to fine outcomes. Key words: Acetabulum; Pelvis; Fractures, bone; Surgical approach

Treatment of complex quadrilateral fractures of the acetabulum with anterior reconstruction titanium plate plus trans-plate quadrilateral screws and improved posterior column lag screws

Objective To summarize our clinical experience in the treatment of complex quadrilateral fractures of the acetabulum with anterior reconstruction titanium plate plus trans-plate quadrilateral screws and improved posterior column lag screws.Methods From March 2010 to January 2013,21 cases of quadrilateral fractures of the acetabulum were treated in our department.They were 13 males and 8 females,aged from 19 to 65 years (average,41.2 years).According to the Letournel classification,there were 11 double-column fractures,5 T-shaped ones and 5 anterior column plus posterior hemi-transverse ones.The average time from injury to operation was 6.5 days (from 4 to 16 days).All cases were treated via the ilioinguinal approach with internal fixation with reconstruction titanium plate plus trans-plate quadrilateral screws and improved posterior column lag screws.Results The operation time for this series ranged from 120 to 270 minutes,averaging 190 minutes.The intraoperative blood bleeding ranged from 300 to 1 800 mL,with an average of 540 mL.By the modified Matta evaluation system,14 cases had anatomic reduction,6 cases satisfactory reduction,and one dissatisfactory reduction.The 21 patients were followed up from 6 to 38 months (average,21.4 months).According to the improved Merled' Aubigne-Postel criteria at the last follow-up,12 cases were rated as excellent,5 good,fair 3 cases,and one poor,giving an excellent-to-good rate of 81.0 ％.The complication rate for this series was 23.8％ (5/21),including 2 cases of lateral femoral cutaneous nerve injury,one case of heterotopic ossification and 2 cases of traumatic arthritis.Conclusion In the treatment of quadrilateral fractures of double columns,T-shaped fractures and anterior column plus posterior hemi-transverse fractures,internal fixation with anterior reconstruction titanium plate plus trans-plate quadrilateral screws and improved posterior column lag screws is really an optimal choice,because it can lead to limited invasion,rigid fixation,fewer complications,and satisfactory outcomes. Key words: Acetabulum; Fractures, bone; Fracture fixation, internal; Bone nails; Bone plates

Surgical Treatment and Reconstruction for Central Giant Cell Granuloma of Mandible- Case Report and Literature Review

Introduction: Central giant cell granuloma (CGCG) is a benign aggressive, highly recurrent, very vascular, rapidly growing with undefined etiology & clinically poorly defined, destructive osteolytic lesion of osteoclastic origin. The central giant cell granuloma is often found in the mandible commonly occurring in patients under the age of 30.CGCG always pose a challenge to oral and maxillofacial surgeon. Because of such a type of nature of these lesions a surgeon’s treatment of choice is radical resection. However, in recent past it has been noticed that complete removal of these lesions by enucleation has not resulted in any recurrence over a period. Purpose: To present a case of CGCG of the lower jaw of a young person in Department of Oral and maxillofacial surgery, Bharati Vidyapeeth Dental College and Hospital, Navi Mumbai. Although en bloc resection provides the lowest recurrence rate, only a few single case reports describe the use of this technique followed by reconstruction with autogenous bone grafts. Material and methods: The medical history of a 18 years patient with a large central giant cell granuloma in the Mandible on the right side extending from canine to the ramus of the mandible. Biopsy specimen taken from the lesion showed CGCG followed by curettage with peripheral ostectomy with preservation of the continuity of the mandible and inferior alveolar bundle. Reconstruction done with titanium reconstruction plate and defect filled with bone graft material. Result: At the end of 12 months clinical and radiological follow up there was no sign of recurrence and showed a well acceptance of the bone graft. Conclusion: After complete healing of the graft, prosthetic rehabilitation with implants will be performed. This allows the best functional and aesthetic results.

Assessment of Position and Symmetry of the Chin Following Reconstruction of Mandible with Autogenous Iliac Bone Grafts and Non Pre-Shaped Titanium Reconstruction Plates: A Comparative Pilot Study of Visual Perception and Computer Analyzed 2D Photo Image

Aim: To restore acceptable facial profile after avulsion or ablation, the missing portions of the mandible must be adequately reconstructed. The purpose of this study was to compare the perception of individuals on mandibular chin dimensions and computer analyzed images following reconstruction of the mandible in a Nigerian tertiary health center. Method: Ten patients with tumors involving the anterior part of the mandible were included. There were 2 groups of assessors. Patients were seated on the dental chair with back rest reclined at 90 degrees. Position of the chin was assessed from the side and symmetry was assessed from the front. Images were transported to computer for analysis. The coronal images were segmented into two halves with a vertical midline. On both sides to the midline, a vertical line was drawn. For the sagittal images, a vertical line was drawn to pass through the nasal sill. Result: From the objective analysis, 5 of the patients had their chin in normal or very close to normal positions, 4 had mild retrusions (≤ 2 mm) and 1 had moderate retrusion (≥ 2). When evaluations were compared, more clinicians graded more accurately than para-clinicians in all the patients. Objectively, 8 patients had less than 2 mm, 1 patient had 2.5 mm and one had 5.5 mm (severe asymmetry). When evaluations were compared, 5 or more assessors in both groups graded correctly in 6 patients. Conclusion: Chin positions were normal based on objective evaluation in half of the cases, while symmetry was very close to normal in only one case.

Use of a single 2.0-mm locking AO reconstruction titanium plate in linear, non-comminuted, mandible fractures.

Purpose:The aim of the following study is to prospectively evaluate the use of a single Arbeitsgemeinschaft für Osteosynthesefragen (AO) 2.0-mm locking reconstruction plate for linear non-comminuted mandibular fractures without the use of a second plate.Materials and Methods:This study consisted of a sample of 10 patients who reported to the department with fractures of the mandible and were treated over a period of 24 months from November 2010 to November 2012. Out of these, there were 8 male patients and 2 female patients. There were four cases of isolated parasymphysis fractures, 1 of the case had a parasymphysis fracture associated with subcondylar fracture, 4 had a body fracture and 2 had a symphysis fracture.Results:All patients had satisfactory fracture reduction and a successful treatment outcome without major complications. Only one patient (10%) developed minor complications.Conclusion:The study has demonstrated that treating linear non-comminuted mandibular fractures with a single AO 2.0-mm locking reconstruction plate provides excellent stability at the fracture site which in turn leads to sound bone healing and early functional rehabilitation.

Combination of Autologous Protein-Rich Fibrin and Bone Graft: An Invaluable Option for Reconstruction of Segmental Mandibular Defects

Combination of Autologous Protein-Rich Fibrin and Bone Graft: An Invaluable Option for Reconstruction of Segmental Mandibular Defects

OP207: Reconstruction technics after total or subtotal glosectomy

Due to functional and psychological sequels, total glosectomy represents a challenge for surgeons. We want to present our experience in this field of reconstruction. This study includes a number of 17 patients, all males, between 2006 and 2012, which underwent total or subtotal glosectomy for scuamous cell carcinoma of the tong. In all cases, reconstruction was performed using microsurgical techniques, with 10 latissimus dorsi free flap which, in three cases was associated with a titanium reconstruction plate for a segmental resection of the mandible; in other patients there was used seven radialis free flap. In three cases was performed prosthetic rehabilitation, in one male using dental implants, and in the other two with mobile prosthesis after the vestibular depthning procedures. All patients received postoperative radiotherapy and in six was associated with chemotherapy. One latissimus dorsi free flap presented total necrosis, so the defect was covered with major pectoralis musculocutaneous flap. After one year postoperative, latissimus dorsis flaps encountered an important volume loss, but this was not the case for radialis free flaps. This conssiderationis very important, because the functional outcome was better with antebrahial flaps. Prosthetic rehabilitation improved functional and esthetic outcome. When anatomical condition of the forearm allows it, is recommended to use radialis free flaps to reconstruct defects after total or subtotal glosectomies, followed by prosthetic rehabilitation. So, the patients can have a near normal quality of life.

Customized Compatible Titanium Plate Reconstruction and Biomechanical Comparative Analysis of Human Mandible Suffering from Lateral Tumor

Customized Compatible Titanium Plate Reconstruction and Biomechanical Comparative Analysis of Human Mandible Suffering from Lateral Tumor

Adenomatoid odontogenic tumor—Report of a posterior mandibular case with the presence of ghost cells

Adenomatoid odontogenic tumor (AOT) occurs more frequently in the maxillary anterior region. Recurrence of AOT after surgical excision is very rare. In this case report, we describe a left posterior mandibular AOT case that exhibited three recurrences after surgical removal. A 25-year-old female patient was first seen by an oral surgeon in a regional hospital with the chief complaint of a swelling at the left mandibular molar region. The tumor was removed by enucleation. Five years later, the tumor recurred at the same region. The patient was referred to our hospital for treatment, and the recurrent tumor was widely excised. The pathological report was an extrafollicular AOT. Eleven years later, the tumor recurred again. It was removed using segmental mandibulectomy with titanium plate reconstruction. The pathological report was also an extrafollicular AOT. Nine months later, the mandibular bone defect was further reconstructed by a segment of iliac bone graft fixed by a new titanium plate and screws. Twenty-eight years after the initial surgery, the tumor recurred again in the alveolar mucosa covering the graft bone. It was further excised, and the pathological report was a peripheral AOT with the presence of amyloid materials and globules of ghost cells. Our AOT case recurred thrice after two conservative excisions and one more radical surgical resection. The multiple recurrences of the tumor indicate the importance of initial complete resection of the tumor. In addition, our case may represent the first reported AOT with the presence of ghost cells in the tumor tissue.

Efficacy of PRP in the Reconstruction of Mandibular Segmental Defects Using Iliac Bone Grafts

This retrospective study was conducted to evaluate the role of platelet-rich plasma (PRP) in the reconstruction of segmental mandibular defects using iliac bone grafts. Thirteen patients underwent reconstruction of post-resection segmental defects of the mandible using titanium reconstruction plates, cortico cancellous iliac bone graft. The patients were randomly separated into two groups. One group of the patients received a PRP graft in addition to the iliac bone graft. Post-operative dimensions of the graft were measured and compared to assess the efficacy of PRP in reconstruction of segmental defects. The post-operative follow-up radiographs confirmed consolidation of the graft in all cases and the segmental defect was obliterated. Thereby mandibular continuity was successfully achieved in all cases. Two patients in the non-PRP group developed an infection and were administered additional antibiotics. The infection was contained and the grafts survived. The use of PRP along with autogenous bone graft may be advantageous since it appeared to enhance the quantity of bone formed. Further long-term follow-up and studies are required to effectively establish the efficacy of PRP and autogenous free bone grafts in the reconstruction of bony defects.