Proximal Redundant Fibula Bone Template for Flap Osteotomies in Mandibular Reconstruction: A Novel Technique

Background

Free fibula flap has been the workhouse of reconstruction for segmental mandibular defects. The use of computer aided design helps in achieving the desired aesthetic and functional outcome. It has its advantages but it comes with an extensive financial burden.

Purpose

We propose the use of redundant proximal fibula bone segment as a template and a cutting guide for flap osteotomies in mandibular reconstruction.

Methods

We have used this surgical technique in a case of T4 oral cancer that required segmental mandibulectomy.

Result

Average ischaemia time was 1 hour and 30 minutes. Based on histopathology report, both the patients required adjuvant radiotherapy. Oral competence was maintained in both the patients. Post-operatively, the contour and the orientation of the mandibular reconstruction were comparable both clinically and radiologically to the previously planned 3D cases.

Conclusion

This surgical technique provides an accurate guide for end angle osteotomy. In addition, it does not require any extra surgical step and does not increase the ischemia time of the flap with no additional extra cost.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12663-021-01567-4.

Rabbit calvarial and mandibular critical-sized bone defects as an experimental model for the evaluation of craniofacial bone tissue regeneration

INTRODUCTION

Many studies have aimed to investigate the regeneration potential of bone substitutes through animal models at different defect sites, where the bone healing mechanism varies due to developmental, structural and functional differences. This study aims to develop a rabbit model with two functionally different (non-load-bearing calvarias and load-bearing mandibular) critical-sized defects (CSD) in one rabbit.

MATERIAL & METHOD

The comparison of the "gold standard" autograft to a sham (no graft) control was undertaken in order to validate this model; at the same time, a 3D-printed biphasic calcium phosphate scaffold was implanted to test its utility in the evaluation of new bone substitute materials. Twenty rabbits were selected with both a 10 mm calvaria defect and a 11 mm bicortical semi-cylindrical mandibular defect. The animals were euthanized at 4 and 12 weeks once surgery, microcomputed tomography and histological analysis had been performed.

RESULTS

In the case of the calvaria, the results for the non-healing sham group compared with the healing of those that had undergone the autograft validated the CSD model. But the mandibular defect was not validated, due to the particularity of mandible high mechanical stress and infectious risk.

DISCUSSION

This study showed for the first time that rabbits have a high tolerance for the bilateral double-site CSD model under consideration; and further studies are essential to modify and improve the design of mandibular CSD.

Local delivery of recombinant human FGF7 enhances bone formation in rat mandible defects

Fibroblast growth factor 7 (FGF7) plays an important role in regulating the proliferation, migration, and differentiation of cells. However, the role of FGF7 in bone formation is not yet fully understood. We examined the effect of FGF7 on bone formation using a rat model of mandible defects. Rats underwent mandible defect surgery and then either scaffold treatment alone (control group) or FGF7-impregnated scaffold treatment (FGF7 group). Micro-CT and histological analyses revealed that the FGF7 group exhibited greater bone formation than did the control group 10 weeks after surgery. With the exception of total porosity (%), all bone parameters had higher values in the FGF7 group than in the control group at each follow-up after surgery. The FGF7 group showed greater expression of osteogenic markers, such as runt-related transcription factor 2, osterix, osteocalcin, bone morphogenetic protein 2, osteopontin, and type I collagen in newly formed bone than did the control group. The delivery of FGF7 also increased the messenger RNA expression of stromal-cell-derived factor 1 (SDF-1) and CXCR4 in newly formed bone in the FGF7 group compared with the control group. Further, addition of exogenous FGF7 induced migration of rat bone marrow stromal cells and increased the expression of SDF-1 and CXCR4 in the cells. Furthermore, the addition of FGF7 augmented mineralization in the cells with increased expression of osteogenic markers, and this augmentation was significantly suppressed by an inhibitor specific for c-Jun N-terminal kinase (SP600125) or extracellular-signal-regulated kinase (PD98059). Collectively, these results suggest that local delivery of FGF7 increases bone formation in a mandible defect with enhanced osteogenesis and chemoattraction.

Micro-computed tomography analysis of early stage bone healing using micro-porous titanium mesh for guided bone regeneration: preliminary experiment in a canine model

The aim of this study was to evaluate the amount of bone formation beneath a defect area after treatment with titanium mesh membranes with different thicknesses and pore sizes alone or in combination with bone graft to induce bone formation during the early stage of healing time. The mandibular premolars were extracted bilaterally from three adult beagle dogs, and 8-mm-diameter bone defects were created on the buccal site of the premolar regions. Hydroxyapatite bone graft substitute was applied in the defect site unilaterally, and other site was left empty. Then, a novel micro-porous mesh (50 μm in pore diameter) or commercially available macro-porous titanium mesh (1700 μm in pore diameter) was placed on the defect and secured with screws. After 4 weeks, the mandibles were harvested, imaged using micro-computed tomography, and prepared for histological and morphometric evaluation. Higher new bone volumes (mm³), percentage of new bone volumes in the total defect volumes (bone ratio: %), and new bone area (mm²) through morphometric evaluation were found on the novel membranes with 50-μm-diameter pores compared to the commercial titanium mesh. Moreover, experiment sites without bone graft were observed with higher new bone volume and bone ratio compared with sites with bone graft. However, bone mineral density of novel mesh was observed to be lower compared with other experimental sites. Under the experimental condition, the result of this study suggests that titanium meshes with 50-μm-diameter pores were effective for guided bone regeneration in the early stage of healing.