Clinical Usefulness of Mandibular Reconstruction Using Custom-Made Titanium Mesh Tray and Autogenous Particulate Cancellous Bone and Marrow Harvested From Tibia and/or Ilia

Abstract

The objective of this study was to evaluate usefulness of mandibular reconstructions using custom-made titanium mesh (Ti-mesh) tray and particulate cancellous bone and marrow (PCBM). Consecutive 21 patients who underwent mandibular reconstruction were enrolled in this study. They were 13 men and 8 women (mean age, 52.0 years). Virtual reality simulation was performed using computer software based on the preoperative computed tomography data. A 3-dimensional skull model was constructed using 3-dimensional printer. A tray was custom-made from Ti-mesh sheet bent to adapt to the model. After PCBM harvesting from posterior ilia and/or proximal tibia, the tray was fixed to the host bone. New bone formation and configuration of the reconstructed mandible were assessed radiologically. Complications were recorded in each patient during the follow-up period. Patients' satisfaction with postoperative facial contour was evaluated using visual analog scale (VAS score, range, 0-100). In 16 of 21 patients, excellent new bone formation was recognized and expected results were radiologically achieved. In 5 patients, new bone formation was insufficient. Causes of insufficient bone formation included postoperative infection in 2 patients, Ti-mesh tray fracture in 2 patients, and local recurrence of lower gingival cancer in 1 patient. To prevent a tray fracture, a double-layered Ti-mesh tray was useful. Mean VAS score on patients' satisfaction was 77.1. Our results comprehensively suggest that mandibular reconstruction using custom-made Ti-mesh tray and PCBM is clinically useful.

Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios

“…Reconstruction for complex cases most times require a free flap and may at times also require patient-matched implants or patient-matched rigid fixation. ICD-10: C41.0 Malignant neoplasm of bones of skull and face, C41.1 Malignant neoplasm of mandible PubMed Search: ((3D Printing) AND (Malignant Neoplasm Skull)) OR ((Rapid Prototyping) AND (Malignant Neoplasm Skull)) OR ((3D Printing) AND (Malignant Neoplasm Mandible)) OR ((Rapid Prototyping) AND (Malignant Neoplasm Mandible)) OR ((virtual surgical planning) AND (Malignant Neoplasm Mandible)) OR ((patient matched implant) AND (Malignant Neoplasm Mandible)) Results: [ 36 , 55 , 72 , 73 , 82 , 88 , 107 , 111 , 114 , 161 , 202 – 205 , 246 – 300 ] Malignant Neoplasms (Soft Tissue) : Malignant neoplasms of the soft tissue within the craniomaxillofacial region include cancers of the oral cavity (e.g. tongue, floor of mouth maxillary and mandibular gingiva), oropharynx, hypopharynx, orbit, skull base and larynx.…”

Isolation of dental pulp stem cells with high osteogenic potential

“…Autogenous bones harvested from the patient’s own body, such as the iliac bone, scapula, and fibula, have been used for major reconstruction of the maxillofacial area [ 11 ]. This bone grafting requires large-scale surgery, e.g., reconstruction using vascular pedicle bone grafts and particulate cancellous bone marrow with a titanium mesh [ 11 , 12 ]. Autogenous bone from the chin and ramus of the mandible, allogenic bone, and xenogenic bone have been used for minor bone augmentation [ 13 , 14 ].…”

Parametric Mandible Reconstruction Plate

“…This model will then be used to generate a patient-specific mandible reconstruction plate that the surgeon can implant with little or no adjustment. A customised reconstruction plate could improve mandible functionality and aesthetics, and significantly reduce the chance of mandible and/or plate fracture [5]. However, the patient-specific process is complex and time-consuming.…”