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Jeanneton P, De Barros A, Alshehri S, Poulet V, Cavallier Z, Prevost A, Lopez R. Arterial vascularization of the mandible and soft tissues. Anatomic study. Surg Radiol Anat 2024; 46:1219-1230. [PMID: 38888835 DOI: 10.1007/s00276-024-03320-1] [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: 11/15/2023] [Accepted: 02/01/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE The literature has for too long described the arterial supply of the mandible as coming from a single artery, the inferior alveolar artery, and being of the terminal type. Rather, it appears to come from an extensive and complex arterial network dependent on the lingual, facial, and maxillary arteries and their collateral branches. Our study aims to confirm and demonstrate the arterial vascular richness of the mandible and to establish arterial mapping. METHODS The arterial vascularization of the mandible was revealed in six anatomic specimens after performing selective injections of the lingual, facial, and maxillary arteries with different dyes. A specimen was injected intra-arterially with colored latex at the level of the maxillary artery for a morphometric study. RESULTS Eighteen selective arterial injections were performed on six anatomic specimens. The mucocutaneous, musculoperiosteal, and intramedullary vascularizations were analyzed. Each of the arteries has a defined and delimited cutaneo-mucous vascular territory. The facial and maxillary arteries supply the musculoperiosteal vascularization of the mandible from the condyle to the symphysis. The lingual artery supplies only the inner cortex of the parasymphyseal and symphyseal regions. The facial and maxillary arteries provide intramedullary vascularization from the angle of the mandible to the parasymphysis. The vascularization of the symphysis depends on the facial artery. No staining was found in the condyle region. Neoprene latex injection was performed on an anatomic specimen, revealing a permeable anastomosis between the inferior alveolar and facial arteries. CONCLUSION The arterial vascularization of the mandible is dependent on the maxillary, facial, and lingual arteries. This is a network vasculature. This study makes it possible to establish an arterial map of the mandible. The presence of an anastomosis between the inferior alveolar artery and the facial artery confirms the existence of dynamic and borrowed vascularization. Knowledge of this arterial system makes it possible to adapt maxillofacial surgical care and to anticipate possible intraoperative complications.
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Affiliation(s)
- P Jeanneton
- Maxillo-Facial Surgery Department, Toulouse Purpan University Hospital, Place du Docteur-Baylac, 31059, Toulouse, France
- Anatomy Laboratory, Faculty of Medicine, University of Medicine Toulouse - Purpan, Toulouse III Paul Sabatier, 31062, Toulouse, France
| | - A De Barros
- Neurosurgery Department, Toulouse Purpan University Hospital, Place du Docteur-Baylac, 31059, Toulouse, France
- Anatomy Laboratory, Faculty of Medicine, University of Medicine Toulouse - Purpan, Toulouse III Paul Sabatier, 31062, Toulouse, France
| | - S Alshehri
- Otolaryngology, Head & Neck Surgery, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - V Poulet
- Maxillo-Facial Surgery Department, Toulouse Purpan University Hospital, Place du Docteur-Baylac, 31059, Toulouse, France
| | - Z Cavallier
- Maxillo-Facial Surgery Department, Toulouse Purpan University Hospital, Place du Docteur-Baylac, 31059, Toulouse, France
| | - A Prevost
- Maxillo-Facial Surgery Department, Toulouse Purpan University Hospital, Place du Docteur-Baylac, 31059, Toulouse, France
| | - R Lopez
- Maxillo-Facial Surgery Department, Toulouse Purpan University Hospital, Place du Docteur-Baylac, 31059, Toulouse, France.
- Anatomy Laboratory, Faculty of Medicine, University of Medicine Toulouse - Purpan, Toulouse III Paul Sabatier, 31062, Toulouse, France.
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Bacterial Colonization of the Condyle in Patients with Advanced Mandibular Osteoradionecrosis: Analysis of Hemimandibulectomy Specimens. Int J Dent 2021; 2021:9998397. [PMID: 34853593 PMCID: PMC8629619 DOI: 10.1155/2021/9998397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022] Open
Abstract
Advanced mandibular osteoradionecrosis (ORN) sometimes requires extended resection (e.g., hemimandibulectomy). Bacterial infection contributes to ORN pathogenesis. To control infection and determine the extent of debridement required, an understanding of bacterial spread within sites of mandibular ORN is important. The current study used a histopathological approach to assess bacterial colonization in the mandibular condyle and elucidate possible paths of bacterial spread towards the mandibular condyle. Four hemimandibulectomy specimens were selected. Areas of bone destruction were macroscopically assessed and confirmed using hematoxylin and eosin staining. Bacterial presence within mandibular condyle was confirmed with Gram staining. Bone exposure was observed in the molar area in all specimens. Macroscopic bone destruction was apparent especially near the medial side of the cortical wall. Gram staining revealed bacterial colonization of the mandibular condyle in three of the four specimens. In conclusion, bacteria tended to spread posteriorly and through the medial side of the mandibular cortical wall. In patients with advanced ORN, the potential for bacterial colonization of the mandibular condyle should be considered during treatment.
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Bouyer M, Garot C, Machillot P, Vollaire J, Fitzpatrick V, Morand S, Boutonnat J, Josserand V, Bettega G, Picart C. 3D-printed scaffold combined to 2D osteoinductive coatings to repair a critical-size mandibular bone defect. Mater Today Bio 2021; 11:100113. [PMID: 34124641 PMCID: PMC8173095 DOI: 10.1016/j.mtbio.2021.100113] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/20/2021] [Accepted: 04/24/2021] [Indexed: 02/03/2023] Open
Abstract
The reconstruction of large bone defects (12 cm3) remains a challenge for clinicians. We developed a new critical-size mandibular bone defect model on a minipig, close to human clinical issues. We analyzed the bone reconstruction obtained by a 3D-printed scaffold made of clinical-grade polylactic acid (PLA), coated with a polyelectrolyte film delivering an osteogenic bioactive molecule (BMP-2). We compared the results (computed tomography scans, microcomputed tomography scans, histology) to the gold standard solution, bone autograft. We demonstrated that the dose of BMP-2 delivered from the scaffold significantly influenced the amount of regenerated bone and the repair kinetics, with a clear BMP-2 dose-dependence. Bone was homogeneously formed inside the scaffold without ectopic bone formation. The bone repair was as good as for the bone autograft. The BMP-2 doses applied in our study were reduced 20- to 75-fold compared to the commercial collagen sponges used in the current clinical applications, without any adverse effects. Three-dimensional printed PLA scaffolds loaded with reduced doses of BMP-2 may be a safe and simple solution for large bone defects faced in the clinic.
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Affiliation(s)
- M. Bouyer
- CEA, CNRS, Université de Grenoble Alpes, ERL5000 BRM, IRIG Institute, 17 Rue des Martyrs, F-38054, Grenoble, France
- CNRS and Grenoble Institute of Engineering, UMR5628, LMGP, 3 Parvis Louis Néel, F-38016, Grenoble, France
- Université Grenoble Alpes, Institut Albert Bonniot, F-38000, Grenoble, France
- Clinique Générale d’Annecy, 4 Chemin de la Tour la Reine, 74000, Annecy, France
| | - C. Garot
- CEA, CNRS, Université de Grenoble Alpes, ERL5000 BRM, IRIG Institute, 17 Rue des Martyrs, F-38054, Grenoble, France
- CNRS and Grenoble Institute of Engineering, UMR5628, LMGP, 3 Parvis Louis Néel, F-38016, Grenoble, France
| | - P. Machillot
- CEA, CNRS, Université de Grenoble Alpes, ERL5000 BRM, IRIG Institute, 17 Rue des Martyrs, F-38054, Grenoble, France
- CNRS and Grenoble Institute of Engineering, UMR5628, LMGP, 3 Parvis Louis Néel, F-38016, Grenoble, France
| | - J. Vollaire
- Université Grenoble Alpes, Institut Albert Bonniot, F-38000, Grenoble, France
- INSERM U1209, Institut Albert Bonniot, F-38000, Grenoble, France
| | - V. Fitzpatrick
- CNRS and Grenoble Institute of Engineering, UMR5628, LMGP, 3 Parvis Louis Néel, F-38016, Grenoble, France
| | - S. Morand
- CEA, CNRS, Université de Grenoble Alpes, ERL5000 BRM, IRIG Institute, 17 Rue des Martyrs, F-38054, Grenoble, France
- CNRS and Grenoble Institute of Engineering, UMR5628, LMGP, 3 Parvis Louis Néel, F-38016, Grenoble, France
- Service de Chirurgie Maxillo-faciale, Centre Hospitalier Annecy Genevois, 1 Avenue de l'hôpital, 74370, Epagny Metz-Tessy, France
| | - J. Boutonnat
- Unité Médico-technique d’Histologie Cytologie Expérimentale, Faculté de Médecine, Université Joseph Fourier, 38700, La Tronche, France
- Département d’Anatomie et Cytologie Pathologique, Institut de Biologie et de Pathologie, Centre Hospitalier Universitaire de Grenoble, France
| | - V. Josserand
- Université Grenoble Alpes, Institut Albert Bonniot, F-38000, Grenoble, France
- INSERM U1209, Institut Albert Bonniot, F-38000, Grenoble, France
| | - G. Bettega
- Université Grenoble Alpes, Institut Albert Bonniot, F-38000, Grenoble, France
- INSERM U1209, Institut Albert Bonniot, F-38000, Grenoble, France
- Service de Chirurgie Maxillo-faciale, Centre Hospitalier Annecy Genevois, 1 Avenue de l'hôpital, 74370, Epagny Metz-Tessy, France
- Corresponding author.
| | - C. Picart
- CEA, CNRS, Université de Grenoble Alpes, ERL5000 BRM, IRIG Institute, 17 Rue des Martyrs, F-38054, Grenoble, France
- CNRS and Grenoble Institute of Engineering, UMR5628, LMGP, 3 Parvis Louis Néel, F-38016, Grenoble, France
- Institut Universitaire de France, 1 Rue Descartes, 75231, Paris Cedex 05, France
- Corresponding author.
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Petnehazy O, Donko T, Ellis R, Csoka A, Czeibert K, Baksa G, Zucker E, Repa K, Takacs A, Repa I, Moizs M. Creating a cross-sectional, CT and MR atlas of the Pannon minipig. Anat Histol Embryol 2021; 50:562-571. [PMID: 33529429 DOI: 10.1111/ahe.12657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/20/2020] [Accepted: 12/19/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to create a detailed cross-sectional anatomical reference atlas of the Pannon minipig by correlating good resolution CT and MR images with high quality cross-sectional anatomical images. According to the authors knowledge, no detailed anatomical atlas is available for the minipig. MATERIAL AND METHOD An adult female minipig was utilized for this purpose. The animal was placed in a PVC half tube, and CT generated images of 0.6 mm slice thickness and MR images of 1.41 mm slice thickness were obtained. The images covered the whole body from the most rostral portion of the snout to the tip of the tail. The CT and MR scans were aligned with frozen anatomical sections prepared with an anatomical band saw from the same animal and significant structures were identified and labelled. The terminology employed has been referenced from the Nomina Anatomica Veterinaria 6th edition-2017. FINDINGS AND CONCLUSIONS The resulting atlas consists of 109 anatomical slices and the corresponding 109 CT and 109 MR scans (altogether 327 images) and the nomenclature list for each image. Although this publication contains limited images of the resulted atlas, it is a reference source for anatomy education and clinical sciences. We are of the opinion that more comprehensive and especially online available interactive atlases should be prepared using similar methodology.
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Affiliation(s)
- Ors Petnehazy
- Medicopus Nonprofit Ltd, Kaposvar, Hungary.,Kaposvar Campus, Szent Istvan University, Kaposvar, Hungary
| | - Tamas Donko
- Medicopus Nonprofit Ltd, Kaposvar, Hungary.,Kaposvar Campus, Szent Istvan University, Kaposvar, Hungary
| | - Rosie Ellis
- The Veterinary Referral & Emergency Centre, Godstone, England
| | - Adam Csoka
- Medicopus Nonprofit Ltd, Kaposvar, Hungary.,Kaposvar Campus, Szent Istvan University, Kaposvar, Hungary
| | - Kalman Czeibert
- Department of Ethology, Institute of Biology, Eötvös Loránd University, Budapest, Hungary
| | - Gabor Baksa
- Department of Anatomy, Histology and Embryology, Semmelweis University of Medical Sciences, Budapest, Hungary
| | - Eric Zucker
- Veterinary Medicine Program, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Krisztina Repa
- Radiation Oncology, Research and Teaching Center, Moritz Kaposi General Hospital Dr. József Baka Diagnostic, Kaposvar, Hungary.,Moritz Kaposi General Hospital, Kaposvar, Hungary
| | | | - Imre Repa
- Medicopus Nonprofit Ltd, Kaposvar, Hungary.,Radiation Oncology, Research and Teaching Center, Moritz Kaposi General Hospital Dr. József Baka Diagnostic, Kaposvar, Hungary
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Kubota H, Miyawaki D, Mukumoto N, Ishihara T, Matsumura M, Hasegawa T, Akashi M, Kiyota N, Shinomiya H, Teshima M, Nibu KI, Sasaki R. Risk factors for osteoradionecrosis of the jaw in patients with head and neck squamous cell carcinoma. Radiat Oncol 2021; 16:1. [PMID: 33402192 PMCID: PMC7786900 DOI: 10.1186/s13014-020-01701-5] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate factors associated with osteoradionecrosis of the jaw (ORNJ) in patients with head and neck squamous cell carcinoma (HNSCC), focusing on jaw-related dose-volume histogram (DVH) parameters. METHODS We retrospectively reviewed the medical records of 616 patients with HNSCC treated with curative-intent or postoperative radiation therapy (RT) during 2008-2018. Patient-related (age, sex, history of smoking or alcohol use, diabetes mellitus, performance status, pre-RT dental evaluation, pre- or post-RT tooth extraction), tumor-related (primary tumor site, T-stage, nodal status), and treatment-related (pre-RT surgery, pre-RT mandible surgery, induction or concurrent chemotherapy, RT technique) variables and DVH parameters (relative volumes of the jaw exposed to doses of 10 Gy-70 Gy [V10-70]) were investigated and compared between patients with and without ORNJ. The Mann-Whitney U test was used to compare RT dose parameters. Univariate and multivariate Cox regression analyses were used to assess factors associated with ORNJ development. Kaplan-Meier analyses were performed for cumulative ORNJ incidence estimation. RESULTS Forty-six patients (7.5%) developed ORNJ. The median follow-up duration was 40 (range 3-145) months. The median time to ORNJ development was 27 (range 2-127) months. DVH analysis revealed that V30-V70 values were significantly higher in patients with than in those without ORNJ. In univariate analyses, primary tumor site, pre-RT mandible surgery, post-RT tooth extraction, and V60 > 14% were identified as important factors. In multivariate analyses, V60 > 14% (p = 0.0065) and primary tumor site (p = 0.0059) remained significant. The 3-year cumulative ORNJ incidence rates were 2.5% and 8.6% in patients with V60 ≤ 14% and > 14%, respectively (p < 0.0001), and 9.3% and 1.4% in patients with oropharyngeal or oral cancer and other cancers, respectively (p < 0.0001). CONCLUSIONS V60 > 14% and oropharyngeal or oral cancer were found to be independent risk factors for ORNJ. These findings might be useful to minimize ORNJ incidence in HNSCC treated with curative RT.
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Affiliation(s)
- Hikaru Kubota
- Division of Radiation Oncology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Daisuke Miyawaki
- Division of Radiation Oncology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Naritoshi Mukumoto
- Division of Radiation Oncology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Takeaki Ishihara
- Division of Radiation Oncology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Megumi Matsumura
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naomi Kiyota
- Kobe University Hospital Cancer Center, Kobe, Japan
| | - Hirotaka Shinomiya
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masanori Teshima
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryohei Sasaki
- Division of Radiation Oncology, Kobe University Hospital, Kobe, Hyogo, Japan.
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Full Facial Allotransplantation Including the Temporomandibular Joints: A Radiologic and Anatomical Cadaveric Study. Plast Reconstr Surg 2020; 146:622-632. [PMID: 32459733 DOI: 10.1097/prs.0000000000007069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Facial allotransplantation including the temporomandibular joints may improve the functional outcomes in face transplant candidates who have lost or damaged this joint. METHODS Linear and angular measurements were taken in 100 dry skulls and mandibles and in 100 three-dimensionally-reconstructed facial computed tomographic scans to determine the variability of the temporomandibular joint, glenoid fossa, and mandible. A vascular study was performed in six fresh cadaveric heads, followed by harvest of the face allograft in three heads. Next, four heads were used for mock transplantation (two donors and two recipients). The full facial allograft included four different segments: a Le Fort III, a mandibular tooth-bearing, and two condyle and temporomandibular joint-bearing segments. Statistical analysis was performed using SAS software. RESULTS In only one-third of the skulls, the condylar shape was symmetric between right and left sides. There was a wide variability in the condylar coronal (range, 14.3 to 23.62 mm) and sagittal dimensions (range, 5.64 to 10.96 mm), medial intercondylar distance (range, 66.55 to 89.91 mm), and intercondylar angles (range, 85.27 to 166.94 degrees). This high variability persisted after stratification by sex, ethnicity, and age. The temporomandibular joint was harvested based on the branches of the superficial temporal and maxillary arteries. The design of the allograft allowed fixation of the two condyle and temporomandibular joint-bearing segments to the recipient skull base, preserving the articular disk-condyle-fossa relationship, and differences were adjusted at the bilateral sagittal split osteotomy sites. CONCLUSION Procurement and transplantation of a temporomandibular joint-containing total face allograft is technically feasible in a cadaveric model.
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Baek KW, Dard M, Zeilhofer HF, Cattin PC, Juergens P. Comparing the Bone Healing After Cold Ablation Robot-Guided Er:YAG Laser Osteotomy and Piezoelectric Osteotomy-A Pilot Study in a Minipig Mandible. Lasers Surg Med 2020; 53:291-299. [PMID: 32529785 DOI: 10.1002/lsm.23281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVE To take major advantage of erbium-doped yttrium aluminium garnet (Er:YAG) lasers in osteotomy-like freedom of cutting geometries and high accuracy-the integration and miniaturization of the robot, laser, and navigation technology was tried and applied to minipigs. The investigators hypothesized laser osteotomy would render acceptable bone healing based on the intraoperative findings and postoperative cut surface analysis. STUDY DESIGN/MATERIALS AND METHODS We designed and implemented a comparative bone-cutting surgery in the minipig mandible with a cold ablation robot-guided Er:YAG laser osteotome (CARLO) and a piezoelectric (PZE) osteotome. The sample was composed of different patterns of defects in the mandibles of six grown-up female Goettingen minipigs. The predictor variable was Er:YAG osteotomy and PZE osteotomy. The outcome variable was the cut surface characteristics and bone healing at 4 and 8 weeks postoperatively. Descriptive and qualitative comparison was executed. RESULTS The sample was composed of four kinds of bone defects on both sides of the mandibles of six minipigs. We observed more bleeding during the operation, open-cut surfaces, and a faster healing pattern with the laser osteotomy. There was a possible association between the intraoperative findings, postoperative cut surface analysis, and the bone healing pattern. CONCLUSIONS The results of this study suggest that characteristic open-cut surfaces could explain favorable bone healing after laser osteotomy. Future studies will focus on the quantification of the early healing characteristics after laser osteotomy, its diverse application, and the safety feature. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Kyung-Won Baek
- Department of Biomedical Engineering, Hightech Research Center of Cranio-Maxillofacial Surgery (HFZ), University of Basel, Gewerbestrasse 14-16, Allschwil, 4123, Switzerland
| | - Michel Dard
- Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, New York.,Institut Straumann AG, Peter Merian-Weg 12, Basel, 4002, Switzerland
| | - Hans-Florian Zeilhofer
- Department of Biomedical Engineering, Hightech Research Center of Cranio-Maxillofacial Surgery (HFZ), University of Basel, Gewerbestrasse 14-16, Allschwil, 4123, Switzerland
| | - Philippe C Cattin
- Department of Biomedical Engineering, Center for Medical Image Analysis & Navigation, University of Basel, Gewerbestrasse 14, Allschwil, 4123, Switzerland
| | - Philipp Juergens
- Department of Cranio-Maxillofacial Surgery, University Hospital of Basel, Spitalstrasse 21, Basel, 4031, Switzerland.,MKG-Chirurgie Arabellapark Praxis für Mund-, Kiefer- und Gesichtschirurgie, Arabellastr. 17, München, 81925, Germany
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Reply. Plast Reconstr Surg 2019; 143:436e-437e. [DOI: 10.1097/prs.0000000000005230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Arterial Vascularization of the Mandibular Condyle and Fractures of the Condyle. Plast Reconstr Surg 2018; 143:435e-436e. [PMID: 30516742 DOI: 10.1097/prs.0000000000005229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Akashi M, Wanifuchi S, Iwata E, Takeda D, Kusumoto J, Furudoi S, Komori T. Differences between osteoradionecrosis and medication-related osteonecrosis of the jaw. Oral Maxillofac Surg 2018; 22:59-63. [PMID: 29224060 DOI: 10.1007/s10006-017-0667-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/05/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE The appearance of osteoradionecrosis (ORN) and medication-related osteonecrosis of the jaw (MRONJ) is similar, but clinically important differences between ORN and MRONJ exist. The aim of this study was to compare the clinical data between ORN and MRONJ and to reveal the critical differences between these diseases. METHODS We retrospectively reviewed the epidemiological data, clinical findings, and treatment in 27 ORN and 61 MRONJ patients. Radiographic signs before the initiation of treatment were also assessed. RESULTS The median age (P = 0.0474) and the ratio of female to male patients (P < 0.0001) were significantly higher in MRONJ patients. There were significantly more MRONJ patients who reported a history of pain when compared with ORN patients (P = 0.0263). As an aetiological factor, tooth extraction was significantly more relevant to MRONJ than ORN (P = 0.0352). When assessing the radiographic signs on computed tomographic images, periosteal reaction was found only in MRONJ patients (P = 0.0158). Minimal debridement was performed significantly more frequently for MRONJ (P = 0.0093), and by contrast, surgical resection was performed more frequently for ORN (P = 0.0002). CONCLUSIONS Understanding the clinical and underlying pathological differences between ORN and MRONJ probably contributes to the selection of appropriate treatment for each patient.
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Affiliation(s)
- Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, 650-0017, Japan.
| | - Satoshi Wanifuchi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, 650-0017, Japan
| | - Eiji Iwata
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, 650-0017, Japan
| | - Daisuke Takeda
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, 650-0017, Japan
| | - Junya Kusumoto
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, 650-0017, Japan
| | - Shungo Furudoi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, 650-0017, Japan
| | - Takahide Komori
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, 650-0017, Japan
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11
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Akashi M, Hashikawa K, Wanifuchi S, Kusumoto J, Shigeoka M, Furudoi S, Terashi H, Komori T. Heterogeneity of Necrotic Changes between Cortical and Cancellous Bone in Mandibular Osteoradionecrosis: A Histopathological Analysis of Resection Margin after Segmental Mandibulectomy. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3125842. [PMID: 28951870 PMCID: PMC5603110 DOI: 10.1155/2017/3125842] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/19/2017] [Accepted: 08/01/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study aimed to analyze differences in necrotic changes between cortical and cancellous bone in resection margins after segmental mandibulectomy for advanced mandibular osteoradionecrosis. METHODS Anteroposterior bone specimens from eleven patients who underwent segmental mandibulectomy with simultaneous free fibula flap reconstruction for advanced osteoradionecrosis were analyzed histopathologically for the presence of necrotic bone based on the presence of blood vessels within Haversian canals. RESULTS Ten of eleven (91%) cortices near the inferior border of the mandible at the anterior margins were necrotic. All cancellous bones at the anterior margins were viable. Seven of eleven (64%) cortices near the inferior border of the mandible at the posterior margins were necrotic. Three of eleven (27%) cancellous bones at the posterior margins were necrotic. CONCLUSION Necrotic changes are more prevalent in cortices than in cancellous bones in mandibular osteoradionecrosis, probably due to a decrease of periosteal blood supply caused by radiotherapy.
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Affiliation(s)
- Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazunobu Hashikawa
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoshi Wanifuchi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junya Kusumoto
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Manabu Shigeoka
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- Division of Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shungo Furudoi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahide Komori
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Bone Regeneration Induced by Bone Porcine Block with Bone Marrow Stromal Stem Cells in a Minipig Model of Mandibular "Critical Size" Defect. Stem Cells Int 2017; 2017:9082869. [PMID: 28553359 PMCID: PMC5434233 DOI: 10.1155/2017/9082869] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/02/2016] [Accepted: 03/19/2017] [Indexed: 12/23/2022] Open
Abstract
Introduction. Adding stem cells to biodegradable scaffolds to enhance bone regeneration is a valuable option. Different kinds of stem cells with osteoblastic activity were tested, such as bone marrow stromal stem cells (BMSSCs). Aim. To assess a correct protocol for osteogenic stem cell differentiation, so BMSSCs were seeded on a bone porcine block (BPB). Materials and Methods. Bone marrow from six minipigs was extracted from tibiae and humeri and treated to isolate BMSSCs. After seeding on BPB, critical-size defects were created on each mandible of the minipigs and implanted with BPB and BPB/BMSSCs. After three months, histomorphometric analysis was performed. Results. Histomorphometric analysis provided percentages of the three groups. Tissues present in control defects were 23 ± 2% lamellar bone, 28 ± 1% woven bone, and 56 ± 4% marrow spaces; in BPB defects were 20 ± 5% BPB, 32 ± 2% lamellar bone, 24 ± 1% woven bone, and 28 ± 2% marrow spaces; in BPB/BMSSCs defects were 17 ± 4% BPB/BMSSCs, 42 ± 2% lamellar bone, 12 ± 1% woven bone, and 22 ± 3% marrow spaces. Conclusion. BPB used as a scaffold to induce bone regeneration may benefit from the addition of BDPSCs in the tissue-engineered constructs.
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Poort LJ, Ludlage JH, Lie N, Böckmann RA, Odekerken JC, Hoebers FJ, Kessler PA. The histological and histomorphometric changes in the mandible after radiotherapy: An animal model. J Craniomaxillofac Surg 2017; 45:716-721. [DOI: 10.1016/j.jcms.2017.02.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/15/2017] [Accepted: 02/13/2017] [Indexed: 02/07/2023] Open
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Simons WF, De Smit M, Duyck J, Coucke W, Quirynen M. The proportion of cancellous bone as predictive factor for early marginal bone loss around implants in the posterior part of the mandible. Clin Oral Implants Res 2014; 26:1051-9. [DOI: 10.1111/clr.12398] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Willem-Frederik Simons
- Department of Oral Health Sciences; KU Leuven; University Hospitals Leuven; Leuven Belgium
| | - Menke De Smit
- Department of Oral Health Sciences; KU Leuven; University Hospitals Leuven; Leuven Belgium
| | - Joke Duyck
- Department of Oral Health Sciences; KU Leuven; University Hospitals Leuven; Leuven Belgium
| | - Wim Coucke
- Department of Clinical Biology; Scientific Institute of Public Health; Brussels Belgium
| | - Marc Quirynen
- Department of Oral Health Sciences; KU Leuven; University Hospitals Leuven; Leuven Belgium
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15
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Establishing a critical-size mandibular defect model in growing pigs: characterization of spontaneous healing. J Oral Maxillofac Surg 2014; 72:1852-68. [PMID: 24815793 DOI: 10.1016/j.joms.2014.02.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/23/2014] [Accepted: 02/13/2014] [Indexed: 12/20/2022]
Abstract
PURPOSE A large animal model is desired for preclinical studies aimed at reconstructing severe mandibular skeletal defects using tissue engineering techniques. To identify the size and location requirements for a mandibular critical-size bone defect in growing pigs, the present study investigated the spontaneous healing of surgically created mandibular defects. MATERIALS AND METHODS Six 4-month-old domestic pigs were used. In pigs 1 and 2, a 3-, 5-, or 7-cm(3) subperiosteal mandibular defect was created. In pigs 3 to 6, 3- to 5-cm(3) bilateral defects were randomly created at the anterior (apical to the molars) and posterior (mandibular angle) mandibular regions. Spontaneous healing of these defects was assessed by serial computed tomography scans (postoperative week 1, 6, and 12) and histologic analyses. RESULTS In pigs 1 and 2, regardless of defect size, the anterior, but not posterior, defects had largely healed. Systematic analyses of pigs 3 to 6 revealed, first, the extent of defect regeneration from spontaneous healing was significantly less in the posterior than in the anterior defects, with about two thirds and one third of the original defect volume remaining, respectively. Second, histologically, the posterior defects had considerably less regeneration and more evident tapering of the new bone than did the anterior defects. Finally, the buccal periosteum had completely regenerated in the anterior defects, but had only partially done so in the posterior defects. Also, the buccal surface contour was moderately concave in the anterior defects, but it was severely concave in the posterior defects. CONCLUSIONS Despite robust spontaneous healing of mandibular defects in growing pigs, 5-cm(3) defects in the mandibular angle region without buccal periosteum would be a reasonable critical-size defect model relevant to mandibular defects in adolescent humans.
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Štembírek J, Kyllar M, Putnová I, Stehlík L, Buchtová M. The pig as an experimental model for clinical craniofacial research. Lab Anim 2012; 46:269-79. [PMID: 22969144 DOI: 10.1258/la.2012.012062] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The pig represents a useful, large experimental model for biomedical research. Recently, it has been used in different areas of biomedical research. The aim of this study was to review the basic anatomical structures of the head region in the pig in relation to their use in current research. Attention was focused on the areas that are frequently affected by pathological processes in humans: the oral cavity with teeth, salivary gland, orbit, nasal cavity and paranasal sinuses, maxilla, mandible and temporomandibular joint. Not all of the structures have an equal morphology in the pig and human, and these morphological dissimilarities must be taken into account before choosing the pig as an experimental model for regenerative medicine.
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Affiliation(s)
- J Štembírek
- Institute of Animal Physiology and Genetics, vvi, Academy of Sciences of Czech Republic, Brno, Czech Republic
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17
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Lethaus B, Poort L, Yamauchi K, Kloss-Brandstätter A, Boeckmann R, Kessler P. Qualitative bone CT as a tool to assess vascularization in irradiated bone: an animal study. Clin Oral Implants Res 2012; 24:746-9. [PMID: 22524288 DOI: 10.1111/j.1600-0501.2012.02480.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this paper was to find a correlation between laser doppler flowmetry (LDF) and the bone mineral density quotient (BMDQ) to evaluate irradiated bone quality preoperatively. MATERIALS AND METHODS Premolars and molars were extracted from six minipigs. After a three-month healing period, three animals received irradiation at a total dose of 24 Gy. Three months after irradiation, quantitative computed tomography was performed using a calibration bone phantom to determine the 120-position BMDQ in the alveolar bone. A drill template was created to define the exact location for measurement. LDF was then recorded after osteotomy of the residual alveolar ridge. The correlation between the BMDQ and LDF was investigated. RESULTS There was a linear negative correlation between LDF and BMDQ in non-irradiated bone (r = -0.435, P = 0.001) and less pronounced also in irradiated bone (r = -0.309, P = 0.017). In both non-irradiated and irradiated bone, we found distinct differences between the maxilla and mandible with respect to BMDQ. However, a clear difference in mandibular and maxillary vascularity was only seen in non-irradiated bone. CONCLUSION In non-irradiated bone, LDF and BMDQ were inversely correlated. In irradiated bone, the BMDQ alone is not an adequate preoperative tool for evaluating bone quality because it was not correlated with bone perfusion.
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Affiliation(s)
- Bernd Lethaus
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
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18
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Molnar G, Plachtovics M, Baksa G, Patonay L, Mommaerts MY. Intraosseous territory of the facial artery in the maxilla and anterior mandible: implications for allotransplantation. J Craniomaxillofac Surg 2011; 40:180-4. [PMID: 21459012 DOI: 10.1016/j.jcms.2011.03.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 01/22/2011] [Accepted: 03/01/2011] [Indexed: 10/18/2022] Open
Abstract
AIM The aim of this anatomical study was to define the intraosseous vascular territory of the facial artery. The clinical issue is whether ipsilateral facial artery anastomosis will guarantee blood supply to the ipsi- and contralateral mandibular symphyses and maxillae in allotransplantation. MATERIAL AND METHODS Of 10 human cadaveric heads, the left facial artery was injected with a positive contrast agent. The maxillae and mandibular symphyses were investigated with cone-beam computed tomography (CBCT). RESULTS Each ipsilateral maxilla and mandibular bone segment showed contrast medium in the intraosseous vessels. In 50% of cases, this was also the case on the contralateral side of the maxilla and anterior mandible. CONCLUSIONS The maxillae and the mandibular symphyses receive ipsilateral blood supply from the facial artery and, in 50% of cases, also from the contralateral facial artery. Internal maxillary artery anastomosis is not required for a vascularized maxillary bone flap. Additionally, involvement of the submental artery is not needed for a mandibular symphyseal bone flap.
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Affiliation(s)
- Gyongyver Molnar
- Department of Anatomy Histology and Embryology, Semmelweis University, Budapest, Hungary
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19
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Pieri F, Lucarelli E, Corinaldesi G, Fini M, Aldini NN, Giardino R, Donati D, Marchetti C. Effect of mesenchymal stem cells and platelet-rich plasma on the healing of standardized bone defects in the alveolar ridge: a comparative histomorphometric study in minipigs. J Oral Maxillofac Surg 2009; 67:265-72. [PMID: 19138598 DOI: 10.1016/j.joms.2008.06.036] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 03/26/2008] [Accepted: 06/17/2008] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to test the effect of the combination of mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) incorporated into a fluorohydroxyapatite (FHA) scaffold on bone regeneration in cylindrical defects in the edentulous mandibular ridge of minipigs. MATERIALS AND METHODS Two mandibular premolar teeth were extracted bilaterally in 8 adult minipigs. After 2 months, 4 standardized defects of 3.5 mm diameter and 8 mm depth were created in each root site. The defects were randomly grafted with autogenous mandibular bone, FHA alone, PRP-FHA, or MSCs-PRP-FHA. A resorbable collagen membrane was placed over the defect area and the flaps were sutured. The animals were sacrificed 3 months later and biopsy samples were taken from the defect sites for histologic and histomorphometric assessment. RESULTS There was no evidence of inflammation or adverse tissue reaction with either treatment. MSCs-PRP-FHA-treated sites showed new vital bone between residual grafting particles. PRP-FHA- and FHA-treated sites showed residual particles in a background of marrow soft tissue with a moderate quantity of newly formed bone. Autogenous bone (46.97%) and MSCs-PRP-FHA (45.28%) produced a significantly higher amount of vital bone than PRP-FHA (37.95%), or FHA alone (36.03%). Further, the MSCs-PRP-FHA-treated defects showed a significantly higher percentage of contact between graft particles and newly formed bone compared with PRP-FHA and FHA group (59.23% vs 48.37% and 46.43%, respectively). CONCLUSIONS Our results suggest that, in this animal model, the addition of MSCs to PRP-FHA enhances bone formation after 3 months.
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Affiliation(s)
- Francesco Pieri
- Department of Odontostomatological Sciences, University of Bologna, Bologna, Italy.
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Abstract
The article demonstrates the factors of importance in the early and late failures of dental implants based on literature review. An implant location is one of many factors that can influence a success or failure of dental implants. The author identifies and describe four alveolar jaw regions--functional implant zones--with unique characteristics of anatomy, blood supply, pattern of bone resorption, bone quality and quantity, need for bone grafting and other supplemental surgical procedures, and a location-related implant success rate. The article discusses predisposing factors that can lead to early implant failures in different jaw zones. An implant location is investigated as one of these factors. A prior history of trauma to premaxillary region is described in the context of implant success in anterior maxilla. This zone is being referred by the author as the "traumatic zone." The challenges of mandibular posterior implant reconstruction are presented in the context of blood supply to the mandible. A deficiency of vascularization in this region, especially in elderly and edentulous patients, lead the author to refer to this zone as the "ischemic zone." The concept of relative ischemia of the posterior mandible that can develop with age and tooth loss is discussed. A thorough understanding of specifics of each functional implant zone should help to improve successes and prevent failures of dental implants.
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Affiliation(s)
- Len Tolstunov
- Department of Oral and Maxillofacial Surgery, University of the Pacific School of Dentistry, San Francisco, Calif, USA.
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Van den Wyngaert T, Huizing MT, Vermorken JB. Osteonecrosis of the jaw related to the use of bisphosphonates. Curr Opin Oncol 2007; 19:315-22. [PMID: 17545793 DOI: 10.1097/cco.0b013e32819f820b] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Osteonecrosis of the jaw associated with the use of potent nitrogen containing bisphosphonates is a new and challenging clinical entity with a high impact on quality of life. This review attempts to consolidate the rapidly expanding literature into practical guidelines and provides expert consensus for areas of uncertainty. RECENT FINDINGS Diagnostic criteria and a staging system for osteonecrosis of the jaw have been proposed, and histomorphologic analysis has confirmed osteonecrosis of the jaw as a proper disease, distinctively different from osteoradionecrosis. Various guidelines for the management of osteonecrosis of the jaw have been suggested and further retrospective research has provided new insights into its epidemiology. SUMMARY Osteonecrosis of the jaw is a distinct entity of uncertain origin that is increasingly being observed in patients treated with potent aminobisphosphonates, although the etiology is probably multifactorial. Recent data confirm the predisposition of multiple myeloma patients to develop osteonecrosis of the jaw. Although various treatment strategies have been reported, conservative management remains the mainstay of therapy.
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Kingsmill VJ, Gray CM, Moles DR, Boyde A. Cortical vascular canals in human mandible and other bones. J Dent Res 2007; 86:368-72. [PMID: 17384034 DOI: 10.1177/154405910708600413] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The human mandible is highly mineralized. We hypothesized that this is related to the local vascularity of the bone. This could not be examined directly, but, as a surrogate, intracortical vascular canal spaces of the human mandible were studied so that we could determine possible relationships with age, gender, location, dental status, and tissue mineralization. Canal numbers, area, and volume fraction were calculated from quantitative backscattered electron images of human mandibles aged 16-96 years. Data were compared with calvaria, maxilla, lumbar vertebra, femoral neck, and iliac crest. In the mandible, the buccal aspect of the midline was the most porous, the canals being larger and more numerous. The cortical porosity in the posterior of partially dentate mandibles was significantly greater than that of either dentate or edentate mandibles, and there was a significant increase in the size of canals in the mandible with increasing age. Female mandibles had more porous cortices. No relationship was found between cortical porosity and the degree of bone mineralization.
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Affiliation(s)
- V J Kingsmill
- Dental Institute, Barts and The London Queen Mary's School of Medicine and Dentistry, New Road, London, UK, E1 1BB.
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In vivo tetracycline labeling of bone: an intraoperative aid in the surgical therapy of osteoradionecrosis of the mandible. ACTA ACUST UNITED AC 2006; 102:e10-3. [DOI: 10.1016/j.tripleo.2006.05.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Revised: 03/29/2006] [Accepted: 05/03/2006] [Indexed: 11/23/2022]
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Krimmel M, Hoffmann J, Zerfowski M, Reinert S. Central resorption in an iliac crest transplant with microvascular anastomosis--report of 2 cases. J Craniomaxillofac Surg 2003; 31:176-8. [PMID: 12818604 DOI: 10.1016/s1010-5182(03)00021-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION The microvascular iliac crest flap is preferred for repair of segmental mandibular defects. Its viability and constant size are regarded as a great advantage for oral rehabilitation. PATIENTS Two patients with oral cancer and recurrent keratocyst underwent mandibular reconstruction with an iliac crest transplant. Wound healing was uneventful. RESULTS Several years after reconstruction we noticed complete absence of cancellous bone in the transplants. The cortical aspect consisted of vital bone. CONCLUSION Secondary to changes in the blood supply after tissue transfer, microvascular bone transplants may develop complete medullary resorption. Substitution of this central bone is variable and may not happen at all.
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Affiliation(s)
- Michael Krimmel
- Department of Oral and Maxillofacial Surgery, Plastic Surgery of Head and Neck, University Hospital, Tübingen, Germany.
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