1
|
Lynn JV, Lalchandani KB, Daniel M, Urlaub KM, Ettinger RE, Nelson NS, Donneys A, Buchman SR. Adipose-Derived Stem Cells Enhance Graft Incorporation and Mineralization in a Murine Model of Irradiated Mandibular Nonvascularized Bone Grafting. Ann Plast Surg 2023; 91:154-158. [PMID: 37450875 DOI: 10.1097/sap.0000000000003598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Nonvascularized bone grafting represents a practical method of mandibular reconstruction. However, the destructive effects of radiotherapy on native bone preclude the use of nonvascularized bone grafts in head and neck cancer patients. Adipose-derived stem cells have been shown to enhance bone healing and regeneration in numerous experimental models. The purpose of this study was to determine the impact of adipose-derived stem cells on nonvascularized bone graft incorporation in a murine model of irradiated mandibular reconstruction. METHODS Thirty isogenic rats were randomly divided into 3 groups: nonvascularized bone graft (control), radiation with nonvascularized bone graft (XRT), and radiation with nonvascularized bone graft and adipose-derived stem cells (ASC). Excluding the control group, all rats received a human-equivalent dose of radiation. All groups underwent mandibular reconstruction of a critical-sized defect with a nonvascularized bone graft from the contralateral hemimandible. After a 60-day recovery period, graft incorporation and bone mineralization were compared between groups. RESULTS Compared with the control group, the XRT group demonstrated significantly decreased graft incorporation (P = 0.011), bone mineral density (P = 0.005), and bone volume fraction (P = 0.001). Compared with the XRT group, the ASC group achieved a significantly increased graft incorporation (P = 0.006), bone mineral density (P = 0.005), and bone volume fraction (P = 0.013). No significant differences were identified between the control and ASC groups. CONCLUSIONS Adipose-derived stem cells enhance nonvascularized bone graft incorporation in the setting of human-equivalent radiation.
Collapse
Affiliation(s)
- Jeremy V Lynn
- From the Craniofacial Research Laboratory, University of Michigan, Ann Arbor, MI
| | | | | | | | | | | | | | | |
Collapse
|
2
|
Urban I, Sanz-Sánchez I, Monje A, Montero E. Complications and treatment errors in peri-implant hard tissue management. Periodontol 2000 2023; 92:278-298. [PMID: 37016554 DOI: 10.1111/prd.12472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/14/2022] [Accepted: 08/21/2022] [Indexed: 04/06/2023]
Abstract
Bone augmentation procedures aim to regenerate the deficient alveolar ridge to properly place dental implants that are completely surrounded by bone. However, these are invasive and technically demanding surgeries that are not free of either complications or treatment errors. Careful patient selection and preparation is a mandatory process to reduce the rate of complications in bone regeneration procedures, irrespective of the technique used. It is important to assess the cost benefit of the intervention and to evaluate the potential impact on the patient's quality of life, especially in the elderly and medically compromised patients. Most common postoperative complications are wound dehiscences, which may be reduced, at least partially, by proper knowledge of the surgical technique and the craniofacial anatomy. Other complications that may appear are postoperative infections or nerve injuries. The aim of this narrative review is to summarize the best available scientific evidence on the incidence of complications, as well as the ideal strategies for their prevention and management. Depending on the severity of the complication, treatment approaches may vary and can include drug prescription or even surgical re-entries to remove exposed barrier membranes or contaminated bone grafts. Adequate prevention and proper management of complications associated with bone augmentation interventions are a requirement for clinicians carrying out these demanding procedures. A series of cases illustrating proper management of complications in different clinical scenarios is presented.
Collapse
Affiliation(s)
- Istvan Urban
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Periodontology and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Ignacio Sanz-Sánchez
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Alberto Monje
- Department of Periodontology, School of Dentistry, International University of Catalonia, Barcelona, Spain
- Department of Periodontology and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Eduardo Montero
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| |
Collapse
|
3
|
Brandenburg LS, Voss PJ, Mischkowsky T, Kühle J, Ermer MA, Weingart JV, Rothweiler RM, Metzger MC, Schmelzeisen R, Poxleitner P. Donor site morbidity after computer assisted surgical reconstruction of the mandible using deep circumflex iliac artery grafts: a cross sectional study. BMC Surg 2023; 23:4. [PMID: 36624485 PMCID: PMC9830896 DOI: 10.1186/s12893-022-01899-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Computer Assisted Design and Computer Assisted Manufacturing (CAD/CAM) have revolutionized oncologic surgery of the head and neck. A multitude of benefits of this technique has been described, but there are only few reports of donor site comorbidity following CAD/CAM surgery. METHODS This study investigated comorbidity of the hip following deep circumflex iliac artery (DCIA) graft raising using CAD/CAM techniques. A cross-sectional examination was performed to determine range of motion, muscle strength and nerve disturbances. Furthermore, correlations between graft volume and skin incision length with postoperative donor site morbidity were assessed using Spearman's rank correlation, linear regression and analysis of variance (ANOVA). RESULTS Fifteen patients with a mean graft volume of 21.2 ± 5.7 cm3 and a mean incision length of 228.0 ± 30.0 mm were included. Patients reported of noticeable physical limitations in daily life activities (12.3 ± 11.9 weeks) and athletic activities (38.4 ± 40.0 weeks in mean) following surgery. Graft volume significantly correlated with the duration of the use of walking aids (R = 0.57; p = 0.033) and impairment in daily life activities (R = 0.65; p = 0.012). The length of the scar of the donor-site showed a statistically significant association with postoperative iliohypogastric nerve deficits (F = 4.4, p = 0.037). Patients with anaesthaesia of a peripheral cutaneous nerve had a larger mean scar length (280 ± 30.0 mm) than subjects with hypaesthesia (245 ± 10.1 mm) or no complaints (216 ± 27.7 mm). CONCLUSIONS Despite sophisticated planning options in modern CAD/CAM surgery, comorbidity of the donor site following iliac graft harvesting is still a problem. This study is the first to investigate comorbidity after DCIA graft raising in a patient group treated exclusively with CAD/CAM techniques. The results indicate that a minimal invasive approach in terms of small graft volumes and small skin incisions could help to reduce postoperative symptomatology. Trial registration Retrospectively registered at the German Clinical Trials Register (DRKS-ID: DRKS00029066); registration date: 23/05/2022.
Collapse
Affiliation(s)
- Leonard Simon Brandenburg
- grid.5963.9Department of Oral and Maxillofacial Surgery, Clinic, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Pit Jacob Voss
- grid.5963.9Department of Oral and Maxillofacial Surgery, Clinic, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Thomas Mischkowsky
- grid.5963.9Department of Oral and Maxillofacial Surgery, Clinic, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Jan Kühle
- grid.5963.9Department of Orthopedics and Trauma Surgery, Clinic, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Michael Andreas Ermer
- grid.5963.9Department of Oral and Maxillofacial Surgery, Clinic, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Julia Vera Weingart
- grid.5963.9Department of Oral and Maxillofacial Surgery, Clinic, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - René Marcel Rothweiler
- grid.5963.9Department of Oral and Maxillofacial Surgery, Clinic, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Marc Christian Metzger
- grid.5963.9Department of Oral and Maxillofacial Surgery, Clinic, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Rainer Schmelzeisen
- grid.5963.9Department of Oral and Maxillofacial Surgery, Clinic, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Philipp Poxleitner
- grid.5963.9Department of Oral and Maxillofacial Surgery, Clinic, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| |
Collapse
|
4
|
[Relationship between prognosis and different surgical treatments of zygomatic defects: A retrospective study]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022. [PMID: 35435204 PMCID: PMC9069039 DOI: 10.19723/j.issn.1671-167x.2022.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To evaluate the effect and summarize the characteristics of different treatment methods in repairing zygomatic defect. METHODS A total of 37 patients with zygomatic defect were reviewed in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from August 2012 to August 2019. According to the anatomical scope of defect, the zygomatic defects were divided into four categories: Class 0, the defect did not involve changes in zygomatic structure or continuity, only deficiency in thickness or projection; Class Ⅰ, defect was located in the zygomatic body or involved only one process; Class Ⅱ, a single defect involved two processes; Class Ⅲa, referred to a single defect involving three processes and above; Class Ⅲb, referred to zygomatic defects associated with large maxillary defects. The etiology, defect time, defect size and characteristics of zygomatic defects, the repair and reconstruction methods, and postoperative complications were collected and analyzed. Postoperative computed tomography (CT) data were collected to evaluate the outcome of zygomatic protrusion. Chromatographic analysis was used to assess the postoperative stability. RESULTS Among the causes of defects, 25 cases (67.57%) were caused by trauma, and 11 cases (29.73%) were of surgical defects following tumor resection. We performed autologous bone grafts in 19 cases, 6 cases underwent vascularized tissue flap, 5 cases underwent external implants alone, and 7 cases underwent vascularized tissue flap combined with external implants. After the recovery of the affected side, the average difference of the zygomatic projection between the navigation group and the non-navigation group was 0.45 mm (0.20-2.50 mm) and 1.60 mm (0.10-2.90 mm), with a significant difference (P=0.045). Two patients repaired with titanium mesh combined with anterolateral thigh flap had obvious deformation or fracture of titanium mesh; 2 patients with customized casting prosthesis had infection after surgery and fetched out the prosthesis finally. CONCLUSION Autologous free grafts or alloplastic materials may be used in cases without significant structural changes. Pedicle skull flap or vascularized bone tissue flap is recommended for zygomatic bone defects with bone pillar destruction, chronic inflammation, oral and nasal communication or significant soft tissue insufficiency. Titanium mesh can be used to repair a large defect of zygomatic bone, and it is suggested to combine with vascularized bone flap transplantation.
Collapse
|
5
|
Truscott A, Zamani R, Akrami M. Comparing the use of conventional and three-dimensional printing (3DP) in mandibular reconstruction. Biomed Eng Online 2022; 21:18. [PMID: 35305669 PMCID: PMC8934485 DOI: 10.1186/s12938-022-00989-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background There are a number of clinical disorders that require mandibular reconstruction (MR). Novel three-dimensional (3D) printing technology enables reconstructions to be more accurate and beneficial to the patient. However, there is currently no evidence identifying which techniques are better suited for MR, based on the type of clinical disorder the patient has. In this study, we aim to compare 3D techniques with conventional techniques to identify how best to reconstruct the mandible based on the clinical cause that necessitates the reconstructive procedure: cancerous or benign tumours, clinical disorders, infection or disease and trauma or injury. Methods PubMed, Scopus, Embase and Medline were searched to identify relevant papers that outline the clinical differences between 3D and conventional techniques in MR. Data were evaluated to provide a clear outline of suitable techniques for surgery. Results 20 of 2749 papers met inclusion criteria. These papers were grouped based on the clinical causes that required MR into four categories: malignant or benign tumour resection; mandibular trauma/injury and other clinical disorders. Conclusions The majority of researchers favoured 3D techniques in MR. However, due to a lack of standardised reporting in these studies it was not possible to determine which specific techniques were better for which clinical presentations.
Collapse
|
6
|
Migliorini F, Cuozzo F, Torsiello E, Spiezia F, Oliva F, Maffulli N. Autologous Bone Grafting in Trauma and Orthopaedic Surgery: An Evidence-Based Narrative Review. J Clin Med 2021; 10:jcm10194347. [PMID: 34640364 PMCID: PMC8509778 DOI: 10.3390/jcm10194347] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/19/2021] [Accepted: 09/23/2021] [Indexed: 12/11/2022] Open
Abstract
Autologous bone grafting is common in trauma and orthopaedic surgery. Both the Reamer Irrigator Aspirator (RIA) and Iliac Crest Bone Graft (ICBG) aim to obtain autologous bone graft. Although the process of harvesting a bone graft is considered simple, complications may occur. This study examined morbidity and pain at the donor site, blood loss, and iatrogenic fractures, comparing RIA and ICBG. The source of the autologous bone graft, the alternative graft sites, and the storage modalities of the harvested bone marrow were also evaluated. In May 2021, PubMed, Embase, Scopus, and Google Scholar were accessed, with no time constraints. RIA may produce greater blood loss, but with less morbidity and complications, making it a potential alternative source of bone grafting.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, 52074 Aachen, Germany
- Correspondence: ; Tel.: +49-0241-80-35529
| | - Francesco Cuozzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Salerno, Italy; (F.C.); (E.T.); (F.O.); (N.M.)
| | - Ernesto Torsiello
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Salerno, Italy; (F.C.); (E.T.); (F.O.); (N.M.)
| | - Filippo Spiezia
- Ospedale San Carlo Potenza, Via Potito Petrone, 85100 Potenza, Italy;
| | - Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Salerno, Italy; (F.C.); (E.T.); (F.O.); (N.M.)
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Salerno, Italy; (F.C.); (E.T.); (F.O.); (N.M.)
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent ST4 7QB, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, London E1 4DG, UK
| |
Collapse
|
7
|
Postoperative Morbidity and Complications in Elderly Patients after Harvesting of Iliac Crest Bone Grafts. MEDICINA-LITHUANIA 2021; 57:medicina57080759. [PMID: 34440965 PMCID: PMC8401410 DOI: 10.3390/medicina57080759] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 02/01/2023]
Abstract
Background and objectives: In oral and maxillofacial operations, the iliac crest is a commonly used donor site from which to harvest bone for augmentation prior to dental implantation or for reconstruction of jaw defects caused by trauma or pathological lesions. In an aging society, the proportion of elderly patients undergoing iliac crest bone grafting for oral augmentation is growing. Although postoperative morbidity is usually moderate to low, the age and health of the patient should be considered as risk factors for complications and delayed mobilization after the operation. The aim of this retrospective study was to evaluate the postoperative morbidity and complications in elderly patients after the harvesting of iliac crest bone grafts for oral surgery. Material and Methods: Data were collected from a total of 486 patients (aged 7–85) who had a surgical procedure that included the harvesting of iliac crest bone grafts for intraoral transplantation. All patients were operated on between 2005 and 2021 in the Department for Oral and Maxillofacial Surgery of the University Hospital in Aachen, Germany. As parameters for postoperative morbidity and complications, gait disturbances, hypesthesia of cutaneous nerves, incision hernias, iliac crest fractures, delayed wound healing, and unfavorable scar formation at the donor site were all evaluated. Results: The study was performed with 485 patients due to the exclusion of one patient as the only one from whom grafts were taken from both sides. When younger and older patients were compared, neither gait disturbances (p = 0.420), nor hernias (p = 0.239), nor fractures (p = 0.239), nor hypesthesia (p = 0.297), nor wound healing delay (p = 0.294), nor scar problems (p = 0.586) were significantly different. However, the volume of the graft was significantly correlated with the duration of the hospital stay (ρ = 0.30; p < 0.01) but not with gait disturbances (ρ = 0.60; p = 0.597). Additionally, when controlling for age (p = 0.841), sex (p = 0.031), ASA class (p = 0.699), preexisting orthopedic handicaps (p = 0.9828), and the volume of the bone graft (p = 0.770), only male sex was associated with the likelihood of suffering gait disturbances (p = 0.031). Conclusions: In conclusion, harvesting bone grafts from the anterior iliac crest for intraoral augmentation is a safe procedure for both young and elderly patients. Although there is some postoperative morbidity, such as gait disturbances, hypesthesia, scar formation, or delayed wound healing at the donor site, rates for these minor complications are low and mostly of short duration. Major complications, such as fractures or incision hernias, are very rare. However, in our study, the volume of the bone graft was associated with a longer stay in hospital, and this should be considered in the planning of iliac crest bone graft procedures.
Collapse
|
8
|
Accuracy of Computer-Assisted Surgery in Maxillary Reconstruction: A Systematic Review. J Clin Med 2021; 10:jcm10061226. [PMID: 33809600 PMCID: PMC8002284 DOI: 10.3390/jcm10061226] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/13/2021] [Accepted: 03/14/2021] [Indexed: 11/17/2022] Open
Abstract
Computer-assisted surgery (CAS) in maxillary reconstruction has proven its value regarding more predictable postoperative results. However, the accuracy evaluation methods differ between studies, and no meta-analysis has been performed yet. A systematic review was performed in the PubMed, Embase, and Cochrane Library databases, using a Patient, Intervention, Comparison and Outcome (PICO) method: (P) patients in need of maxillary reconstruction using free osteocutaneous tissue transfer, (I) reconstructed according to a virtual plan in CAS software, (C) compared to the actual postoperative result, and (O) postoperatively measured by a quantitative accuracy assessment) search strategy, and was reported according to the PRISMA statement. We reviewed all of the studies that quantitatively assessed the accuracy of maxillary reconstructions using CAS. Twelve studies matched the inclusion criteria, reporting 67 maxillary reconstructions. All of the included studies compared postoperative 3D models to preoperative 3D models (revised to the virtual plan). The postoperative accuracy measurements mainly focused on the position of the fibular bony segments. Only approximate comparisons of postoperative accuracy between studies were feasible because of small differences in the postoperative measurement methods; the accuracy of the bony segment positioning ranged between 0.44 mm and 7.8 mm, and between 2.90° and 6.96°. A postoperative evaluation guideline to create uniformity in evaluation methods needs to be considered so as to allow for valid comparisons of postoperative results and to facilitate meta-analyses in the future. With the proper validation of the postoperative results, future research might explore more definitive evidence regarding the management and superiority of CAS in maxillary and midface reconstruction.
Collapse
|
9
|
The Anterolateral Thigh-Medial Femoral Condyle Chimeric Flow-through Flap for Posttraumatic Wrist Arthrodesis. Tech Hand Up Extrem Surg 2019; 23:143-145. [PMID: 31454335 DOI: 10.1097/bth.0000000000000247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Wrist arthrodesis in the setting of segmental bone loss can have high failure rates. Therefore, vascularized bone grafting has been advocated for select patients. Patients suffering concomitant large soft tissue loss present even greater challenge. To that end, we describe for the first time successful anterolateral thigh-medial femoral condyle chimeric flow-through flap for posttraumatic wrist arthrodesis and soft tissue coverage. This is a case report of a 19-year-old male laborer who suffered a large blast injury resulting in significant bone and soft tissue injury to the dominant right hand and wrist. After multiple debridements, there was a segmental bone defect from the distal radius and ulna to the metacarpal bases, as well as a 12×8 cm dorsal soft tissue defect. This was reconstructed with a anterolateral thigh-medial femoral condyle chimeric flow-through flap and concomitant wrist arthrodesis in a single stage. Besides a donor site thigh seroma, recovery was uneventful with clinical and radiographic evidence of fusion by >9 weeks postoperation.
Collapse
|
10
|
Nonvascularized Bone Graft Reconstruction of the Irradiated Murine Mandible: An Analogue of Clinical Head and Neck Cancer Treatment. J Craniofac Surg 2019; 30:611-617. [PMID: 30531286 DOI: 10.1097/scs.0000000000005032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Nonvascularized bone grafts (NBGs) represent a practical method of mandibular reconstruction that is precluded in head and neck cancer patients by the destructive effects of radiotherapy. Advances in tissue-engineering may restore NBGs as a viable surgical technique, but expeditious translation demands a small-animal model that approximates clinical practice. This study establishes a murine model of irradiated mandibular reconstruction using a segmental iliac crest NBG for the investigation of imperative bone healing strategies. Twenty-seven male isogenic Lewis rats were divided into 2 groups; control bone graft and irradiated bone graft (XBG). Additional Lewis rats served as graft donors. The XBG group was administered a fractionated dose of 35Gy. All rats underwent reconstruction of a segmental, critical-sized defect of the left hemi-mandible with a 5 mm NBG from the iliac crest, secured by a custom radiolucent plate. Following a 60-day recovery period, hemi-mandibles were evaluated for bony union, bone mineralization, and biomechanical strength (P < 0.05). Bony union rates were significantly reduced in the XBG group (42%) compared with controls (80%). Mandibles in the XBG group further demonstrated substantial radiation injury through significant reductions in all metrics of bone mineralization and biomechanical strength. These observations are consistent with the clinical sequelae of radiotherapy that limit NBGs to nonirradiated patients. This investigation provides a clinically relevant, quantitative model in which innovations in tissue engineering may be evaluated in the setting of radiotherapy to ultimately provide the advantages of NBGs to head and neck cancer patients and reconstructive surgeons.
Collapse
|
11
|
|
12
|
van Baar GJC, Forouzanfar T, Liberton NPTJ, Winters HAH, Leusink FKJ. Accuracy of computer-assisted surgery in mandibular reconstruction: A systematic review. Oral Oncol 2018; 84:52-60. [PMID: 30115476 DOI: 10.1016/j.oraloncology.2018.07.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/29/2018] [Accepted: 07/10/2018] [Indexed: 11/18/2022]
Abstract
Computer-assisted surgery (CAS) for mandibular reconstruction was developed to improve conventional treatment methods. In the past years, many different software programs have entered the market, offering numerous approaches for preoperative planning and postoperative evaluation of the CAS process of mandibular reconstruction. In this systematic review, we reviewed planning and evaluation methods in studies that quantitatively assessed accuracy of mandibular reconstruction performed with CAS. We included 42 studies describing 413 mandibular reconstructions planned and evaluated using CAS. The commonest software was Proplan/Surgicase CMF (55%). In most cases, the postoperative virtual 3-dimensional model was compared to the preoperative 3-dimensional model, revised to the virtual plan (64%). The commonest landmark for accuracy measurements was the condyle (54%). Accuracy deviations ranged between 0 mm and 12.5 mm and between 0.9° and 17.5°. Because of a lack of uniformity in planning (e.g., image acquisition, mandibular resection size) and evaluation methodologies, the ability to compare postoperative outcomes was limited; meta-analysis was not performed. A practical and simple guideline for standardizing planning and evaluation methods needs to be considered to allow valid comparisons of postoperative results and facilitate meta-analysis in the future.
Collapse
Affiliation(s)
- Gustaaf J C van Baar
- Department of Oral and Maxillofacial Surgery/Oral Pathology & 3D Innovation Lab, VU University Medical Centre/Academic Centre for Dentistry Amsterdam (ACTA), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Tymour Forouzanfar
- Department of Oral and Maxillofacial Surgery/Oral Pathology & 3D Innovation Lab, VU University Medical Centre/Academic Centre for Dentistry Amsterdam (ACTA), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Niels P T J Liberton
- Department of Oral and Maxillofacial Surgery/Oral Pathology & 3D Innovation Lab, VU University Medical Centre/Academic Centre for Dentistry Amsterdam (ACTA), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Henri A H Winters
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Frank K J Leusink
- Department of Oral and Maxillofacial Surgery/Oral Pathology & 3D Innovation Lab, VU University Medical Centre/Academic Centre for Dentistry Amsterdam (ACTA), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| |
Collapse
|
13
|
Modabber A, Ayoub N, Bock A, Möhlhenrich S, Lethaus B, Ghassemi A, Mitchell D, Hölzle F. Medial approach for minimally-invasive harvesting of a deep circumflex iliac artery flap for reconstruction of the jaw using virtual surgical planning and CAD/CAM technology. Br J Oral Maxillofac Surg 2017; 55:946-951. [DOI: 10.1016/j.bjoms.2017.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 09/11/2017] [Indexed: 11/15/2022]
|
14
|
Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years. Br J Oral Maxillofac Surg 2017; 55:113-126. [DOI: 10.1016/j.bjoms.2016.12.010] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 12/02/2016] [Indexed: 11/19/2022]
|
15
|
Okoturo E. Non-vascularised iliac crest bone graft for immediate reconstruction of lateral mandibular defect. Oral Maxillofac Surg 2016; 20:425-429. [PMID: 27725996 DOI: 10.1007/s10006-016-0585-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 09/22/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Mandibular defect reconstruction is extremely important to achieving an improved quality of life of patients as this bony defect influences facial harmony and aesthetics. Reconstruction of mandibular defects at our centre comprises use of reconstruction plate, non-vascularised anterior iliac crest graft and vascularised fibula flap. Despite the large mandibular defect recorded in our developing environment, non-vascularised iliac crest graft continues to play a role in its exclusive use for lateral mandibular defects. The aim of this study was to analyse the role, complications and outcomes of the use of non-vascularised iliac crest graft for mandibular reconstruction in a free flap-enabled centre. PATIENTS AND METHOD This was a retrospective case cohort from study institution's records of mandibular reconstruction following mandibular surgery for benign tumours. Eligibility for study inclusion comprised case cohort with head and neck diseases requiring mandibular surgery and reconstruction with either reconstruction plate, non-vascularised iliac crest graft or vascularised fibula flap. RESULTS A total of 18 subjects underwent iliac crest grafting. Of the 18 subjects with iliac crest graft, 7 (39 %) were females while 11 (61 %) were males. Ten of the 18 subjects with iliac crest grafting were diagnosed with ameloblastomas. Six (33.3 %) subjects had class H (Jewer's classification) mandibular defect. The average graft length was 5.4 cm and height was 2.3 cm. Three cases experienced graft site complications of which two grafts were lost. All 18 cases experienced good to acceptable clinical outcomes. Predictors of graft outcome were not statistically significant. CONCLUSION Despite our small sample size, it is suggestible that non-vascularised iliac crest graft be considered for lateral mandibular defect reconstruction, considering the reduced graft failure rate and satisfactory clinical outcomes from this study.
Collapse
Affiliation(s)
- Eyituoyo Okoturo
- Maxillofacial Head and Neck Cancer Division, Oral and Maxillofacial Surgery Department, Lagos State University College of Medicine/Teaching Hospital (LASUCOM/LASUTH), Lagos, Nigeria.
| |
Collapse
|
16
|
Aluko-Olokun B, Olaitan AA, Aluko-Olokun OA. Reconstruction of tooth-bearing portion of mandible using polyglactin 910 sutures for internal fixation in the third-world: functional and cosmetic outcome. Oral Maxillofac Surg 2016; 21:13-20. [PMID: 27796608 DOI: 10.1007/s10006-016-0589-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 10/21/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study analyzed the cosmetic and functional outcome of cases involving reconstruction of tooth-bearing portion of the lower jaw, using a polyglactin 910 suture for fixation. PATIENTS AND METHOD This prospective intervention study documented the treatment outcome in 25 consecutive adult patients, who underwent immediate mandibular reconstruction following segmental resection of tooth-bearing portion of mandible. Cortico-cancellous bone graft was taken from the inner table of iliac bone, sparing the crest. Use of post-surgical inter-maxillary fixation was avoided. RESULTS Twenty-five patients were recruited for the study. Seventeen were males and eight were females. Their ages ranged from 18 to 50 years, with a mean of 30.0 years. Average length of grafted bone was 9.8 cm. Following surgery, all 25 (100%) patients were judged to have satisfactory facial symmetry. One (4.0 %) had altered dental occlusion. Twenty-five (100%) had satisfactory bone union. All of the patients claimed to masticate satisfactorily. Assessment was carried out at the last post-operative follow-up visit for each patient who ranged between 22 and 83 months. CONCLUSION Use of polyglactin 910 suture material for fixation in mandibular reconstruction following segmental resection of tooth-bearing portion has proven to be a cosmetic and functional success. It may serve as alternative for those among whom conventional treatment methods may be contraindicated. This method of bone fixation may serve as a reliable and much cheaper alternative in low-income countries. LEVEL OF EVIDENCE Level IV, therapeutic study.
Collapse
|
17
|
Indications of Free Grafts in Mandibular Reconstruction, after Removing Benign Tumors: Treatment Algorithm. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e845. [PMID: 27622113 PMCID: PMC5010336 DOI: 10.1097/gox.0000000000000832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/01/2016] [Indexed: 11/25/2022]
Abstract
Background: Mandibular reconstruction has been the subject of much debate and research in the fields of maxillofacial surgery and head and neck surgery. Materials and Methods: A retrospective observational study was undertaken with 14 patients diagnosed with benign tumorous pathologies and who underwent immediate mandibular resection and reconstruction at the Hospital del Salvador Maxillofacial Surgery Unit and Dr. Rodrigo Fariña’s private clinic between the years 2002 and 2012. We propose a treatment algorithm, which is previous teeth extractions in area that will be removed. Results: Fourteen patients underwent surgery, and a total of 40 dental implants were installed in 6 men and 8 women, the mean age of 33.5 (age range, 14–58 y). Reconstruction with iliac crest bone graft, and rehabilitation following this protocol (average of reconstruction was 8.7 cm), was successful with no complications at all in 12 patients. One patient had a minor complication, and the graft was partially reabsorbed because of communication of the graft with the oral cavity. This complication did not impede rehabilitation with dental implants. Another patient suffered the total loss of the graft due to infection because of dehiscence of oral mucosa and great communication with the mouth. Another iliac crest free graft reconstruction was undertaken 6 months later. Conclusions: The scientific evidence suggests that mandibular reconstruction using free grafts following the removal of benign tumors is a biologically sustainable alternative. The critical factor to improve the prognosis of free grafts reconstruction in benign tumors is to have good quality soft tissue and avoid communication with the oral cavity. For this, it is vital to do dental extractions before removing the tumor.
Collapse
|
18
|
Ghassemi A, Schreiber L, Prescher A, Modabber A, Nanhekhan L. Regions of ilium and fibula providing clinically usable bone for mandible reconstruction: “A different approach to bone comparison”. Clin Anat 2016; 29:773-8. [DOI: 10.1002/ca.22732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/21/2016] [Accepted: 04/24/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Alireza Ghassemi
- Consultant, Oral and Maxillofacial Surgery, Teaching Hospital Klinikum-Lippe, Detmold, Germany and Medical Faculty University of RWTH Aachen; Aachen Germany
| | | | - Andreas Prescher
- Professor, Institute for Molecular and Cellular Anatomy University of RWTH Aachen; Aachen Germany
| | - Ali Modabber
- Associate Professor, Oral and Maxillofacial Surgery, University Hospital RWTH Aachen; Aachen Germany
| | - Lloyd Nanhekhan
- Consultant, Plastic Surgery University Hospital Leuven; Leuven Belgium
| |
Collapse
|
19
|
Posnick JC, Gray JA. Is It Safe to Re-Harvest the Anterior Iliac Crest to Manage Le Fort I Interpositional Defects in Young Adults With a Repaired Cleft? J Oral Maxillofac Surg 2015; 73:S32-9. [DOI: 10.1016/j.joms.2015.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/09/2015] [Indexed: 11/26/2022]
|
20
|
Shu DL, Liu XZ, Guo B, Ran W, Liao X, Zhang YY. Accuracy of using computer-aided rapid prototyping templates for mandible reconstruction with an iliac crest graft. World J Surg Oncol 2014; 12:190. [PMID: 24957053 PMCID: PMC4101797 DOI: 10.1186/1477-7819-12-190] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 06/12/2014] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to evaluate the accuracy of surgical outcomes in free iliac crest mandibular reconstructions that were carried out with virtual surgical plans and rapid prototyping templates. Methods This study evaluated eight patients who underwent mandibular osteotomy and reconstruction with free iliac crest grafts using virtual surgical planning and designed guiding templates. Operations were performed using the prefabricated guiding templates. Postoperative three-dimensional computer models were overlaid and compared with the preoperatively designed models in the same coordinate system. Results Compared to the virtual osteotomy, the mean error of distance of the actual mandibular osteotomy was 2.06 ± 0.86 mm. When compared to the virtual harvested grafts, the mean error volume of the actual harvested grafts was 1412.22 ± 439.24 mm3 (9.12% ± 2.84%). The mean error between the volume of the actual harvested grafts and the shaped grafts was 2094.35 ± 929.12 mm3 (12.40% ± 5.50%). Conclusions The use of computer-aided rapid prototyping templates for virtual surgical planning appears to positively influence the accuracy of mandibular reconstruction.
Collapse
Affiliation(s)
| | | | | | - Wei Ran
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Sun Yat-sen University, No, 58 Zhongshan Er Road, Guangzhou 510080, China.
| | | | | |
Collapse
|
21
|
Ayoub N, Ghassemi A, Rana M, Gerressen M, Riediger D, Hölzle F, Modabber A. Evaluation of computer-assisted mandibular reconstruction with vascularized iliac crest bone graft compared to conventional surgery: a randomized prospective clinical trial. Trials 2014; 15:114. [PMID: 24716651 PMCID: PMC3998950 DOI: 10.1186/1745-6215-15-114] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 03/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Computer-assisted surgery plays an increasingly important role in mandibular reconstruction, ensuring the best possible masticatory function and aesthetic outcome. METHODS Twenty patients were randomly assigned to computer-assisted or conventional mandibular reconstruction with vascularized iliac crest bone graft in a prospective study design.Virtual surgical planning was based on preoperative CT-data using specific surgical planning software. A rapid prototyping guide transferred the virtual surgery plan to the operation site. During surgery the transplant ischemic time, reconstruction time, time for shaping the transplant and amount of bone removed were measured. Additionally, the difference in the intercondylar distance before and after surgery was calculated. RESULTS Computer-assisted surgery shortened the time of transplant ischemia (P < 0.005) and defect reconstruction (P < 0.001) compared to conventional surgery. The time to saw and shape the transplant at the donor site was shorter using conventional surgery (P < 0.005); therefore, the overall time for surgery didn't change (P = 0.527). In the computer-assisted group, the amount of bone harvested equaled the defect size, whereas the transplant size in the conventional group exceeded the defect site by 16.8 ± 5.6 mm (P < 0.001) on average. The intercondylar distance before compared to after surgery was less affected in the computer-assisted than in the conventional group (P < 0.001). CONCLUSIONS The presented study shows that computer-assisted surgery can help reduce the time for mandibular defect reconstruction and consequently the transplant ischemic time. In the computer-assisted group, the iliac crest donor site defect was downsized and the postoperative condyle position was less altered, reducing possible risks of postoperative complications and donor site morbidity. TRIAL REGISTRATION DRKS00005181.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Ali Modabber
- Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital of the RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
| |
Collapse
|
22
|
Gerressen M, Pastaschek CI, Riediger D, Hilgers RD, Hölzle F, Noroozi N, Ghassemi A. Microsurgical Free Flap Reconstructions of Head and Neck Region in 406 Cases: A 13-Year Experience. J Oral Maxillofac Surg 2013; 71:628-35. [DOI: 10.1016/j.joms.2012.07.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 07/03/2012] [Accepted: 07/03/2012] [Indexed: 11/26/2022]
|
23
|
Ghassemi A, Furkert R, Prescher A, Riediger D, Knobe M, O'dey D, Gerressen M. Variants of the supplying vessels of the vascularized iliac bone graft and their relationship to important surgical landmarks. Clin Anat 2013; 26:509-21. [DOI: 10.1002/ca.22199] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 10/03/2012] [Accepted: 10/09/2012] [Indexed: 11/06/2022]
|
24
|
Krohn T, Ghassemi A, Gerressen M, Verburg FA, Mottaghy FM, Behrendt FF. Bone graft scintigraphy. A new diagnostic tool to assess perfusion during surgery. Nuklearmedizin 2012; 51:201-4. [PMID: 22688256 DOI: 10.3413/nukmed-0469-12-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 05/21/2012] [Indexed: 11/20/2022]
Abstract
AIM To evaluate a scintigraphic tool for intraoperative assessment of vascularized bone graft perfusion before and after transplantation. PATIENTS, METHODS This pilot study included three patients scheduled for surgical segmental mandibulectomy followed by reconstruction with a vascularized iliac bone graft. A continuous (99m)Tc-pertechnetate infusion was applied selectively arterial into the blood vessel supplying the respective graft before osteotomy as well as after transplantation. Perfusion was analysed by scintigrams acquired using the intraoperative camera systems declipseSPECT and Sentinella. Results were compared qualitatively. RESULTS Before harvesting the graft, intraoperative scintigraphy revealed a clearly delineated area of the iliac crest with a relatively homogenous pertechnetate distribution representing good perfusion. After osteotomy, transplantation to the mandibula and re-anastomosis of the nutrient vessels, scintigraphy in all patients showed a moderately inhomogenous distribution pattern of the pertechnetate indicating an adequate perfusion of the bone transplant through the arterial anastomosis. CONCLUSION Intraoperative assessment of bone graft perfusion is possible with the imaging systems Sentinella as well as with declipseSPECT using a continuous intra-arterial infusion of 99mTc-pertechnetate.
Collapse
Affiliation(s)
- T Krohn
- University Hospital Aachen, Department of Nuclear Medicine, Germany.
| | | | | | | | | | | |
Collapse
|
25
|
Ghassemi A, Ghassemi M, Modabber A, Knobe M, Fritz U, Riediger D, Gerressen M. Functional long-term results after the harvest of vascularised iliac bone grafts bicortically with the anterior superior iliac spine included. Br J Oral Maxillofac Surg 2012; 51:e47-50. [PMID: 22677214 DOI: 10.1016/j.bjoms.2012.04.257] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 04/07/2012] [Indexed: 11/28/2022]
Abstract
The aim of this study was to evaluate the postoperative morbidity at the donor site and the long-term outcome after the harvest of bicortical iliac bone grafts, including the iliac crest and the anterior superior iliac spine (ASIS), by using a confirmed score. We retrospectively examined 54 consecutive patients who had had vascularised iliac bone grafts harvested to reconstruct different parts of the mandible. We used the Harris Hip Score to evaluate objectively the long-term postoperative morbidity at the donor site. Of 54 patients, 20 were female (37%) and 34 male (63%), with a mean age of 49 years (range 12-81). The causes of the bony defects were malignancy (n=37, 69%), benign tumours (n=7, 13%), osteomyelitis (n=9, 17%), and atrophy of the alveolar ridge (n=1, 2%). All transplants healed adequately. A total of 38/52 patients (73%) had a score of more than 80 points, which defines clinical success. Vascularised iliac bone grafts offer excellent bony dimensions with optimal shape to be used for reconstruction of different parts of the mandible. They can be harvested bicortically, including the iliac crest and the ASIS, with acceptable morbidity at the donor site. The Harris Hip Score is an appropriate tool for the evaluation of long-term impairment at the donor site after the harvest of vascularised iliac bone grafts, and it could be used to compare the results of different studies.
Collapse
Affiliation(s)
- Alireza Ghassemi
- Department of Oral, Maxillofacial and Plastic Facial Surgery, School of Medicine, University Hospital Aachen, Aachen, Germany
| | | | | | | | | | | | | |
Collapse
|
26
|
Modabber A, Gerressen M, Stiller MB, Noroozi N, Füglein A, Hölzle F, Riediger D, Ghassemi A. Computer-assisted mandibular reconstruction with vascularized iliac crest bone graft. Aesthetic Plast Surg 2012; 36:653-9. [PMID: 22395301 DOI: 10.1007/s00266-012-9877-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 02/02/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND The intention of mandibular reconstructive surgery is to achieve maximum possible functionality, which means the restoration of masticatory function and speech with a good esthetic result. METHODS We compared five computer-assisted mandibular reconstructions with 15 conventional mandibular reconstructions performed using vascularized iliac crest bone grafts. Based on preoperative cone beam computed tomography (CBCT) or CT data imported into the specific surgical planning software, a surgical guide was designed by rapid prototyping that helped to exactly translate the virtual surgery plan into the operation site whereby it fit uniquely to the iliac donor site. The ischemic time of the graft was measured intraoperatively and the difference between the amount of bone removed and the amount of bone required was determined. In addition, 3 months after surgery patients had to score the esthetics of their outer appearance using a visual analog scale. RESULTS In all patients the graft fit perfectly into the mandibular defect without major adjustments. The time for the shaping process of the transplant and the ischemic time were shorter than in the conventional grafting procedure. The virtual plan reduced the amount of bone removed to the required volume. The patients who underwent computer-assisted reconstruction had a higher degree of satisfaction with their outer appearance. CONCLUSION Our clinical experience and the collected data suggest that the described method is very promising for optimizing the surgical result of mandibular reconstructions using iliac crest bone grafts and achieving an excellent esthetic outcome. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Collapse
Affiliation(s)
- Ali Modabber
- Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital Aachen, Aachen, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Healing of cavitary bone defects. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2011. [DOI: 10.1007/s00590-011-0831-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
28
|
Mandibular reconstruction using nonvascularized autogenous bone grafting. Curr Opin Otolaryngol Head Neck Surg 2010; 18:227-31. [PMID: 20508523 DOI: 10.1097/moo.0b013e32833a46ed] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This paper will discuss reconstruction of the mandible with autogenous nonvascularized bone grafting. New developments in this area will be investigated by reviewing the most recent literature on this topic as compared with other techniques currently employed. With the advances of vascularized free flap reconstruction it is important to investigate the indication for nonvascularized techniques. RECENT FINDINGS Replacement of a portion of the mandibular bone is a common procedure for patients undergoing ablative cancer surgery or for infection as well as temporomandibular joint replacement secondary to disease or trauma. The subject of mandibular reconstruction has seen great advances in recent years with the advent of vascularized free tissue transfer. Other newer areas of mandibular replacement include tissue engineering and distraction osteogenesis. Traditional nonvascularized autogenous bone graft replacement can still play a vital role in rehabilitating these patients. SUMMARY Although vascularized free flap reconstruction of mandibular defects has become the more common method of treating the postablative cancer surgery patient, there remain indications for nonvascularized reconstruction of mandibular defects as well as other techniques.
Collapse
|
29
|
|