Uncovering the unique characteristics of the mandible to improve clinical approaches to mandibular regeneration

Abstract

The mandible (lower jaw) bone is aesthetically responsible for shaping the lower face, physiologically in charge of the masticatory movements, and phonetically accountable for the articulation of different phonemes. Thus, pathologies that result in great damage to the mandible severely impact the lives of patients. Mandibular reconstruction techniques are mainly based on the use of flaps, most notably free vascularized fibula flaps. However, the mandible is a craniofacial bone with unique characteristics. Its morphogenesis, morphology, physiology, biomechanics, genetic profile, and osteoimmune environment are different from any other non-craniofacial bone. This fact is especially important to consider during mandibular reconstruction, as all these differences result in unique clinical traits of the mandible that can impact the results of jaw reconstructions. Furthermore, overall changes in the mandible and the flap post-reconstruction may be dissimilar, and the replacement process of the bone graft tissue during healing can take years, which in some cases can result in postsurgical complications. Therefore, the present review highlights the uniqueness of the jaw and how this factor can influence the outcome of its reconstruction while using an exemplary clinical case of pseudoarthrosis in a free vascularized fibula flap.

Features and networks of the mandible on computed tomography

“…Furthermore, it is of clinical interest to apply the proposed approach for exploring complex image properties of human mandibles for improving the diagnostics and treatment of facial trauma. It has recently been reported that by considering the uniqueness of the mandible can enhance clinical approaches to mandibular regeneration in order to avoid postsurgical complications [ 1 ]. In parallel to precision medicine [ 31 ], precision dentistry [ 32 , 33 ] is an emerging area of research that has potential to achieve precise dental diagnostics and targeted treatment.…”

“…Thus, understanding characteristics of the mandible such as its morphology, physiology and genetic profile can be helpful for improving mandibular reconstruction. As a result, it can accelerate the healing process and prevent the patient from postsurgical complications [ 1 ].…”

Thoughts on the Etiology of Cherubism

“…-Mice have a different dental development and signaling pathways than humans: while all teeth are laid down prenatally in mice, in humans, the formation of the second and third molars only occurs postnatally via the replacement dentition, parallel to the formation of the first symptoms of classic cherubism. -While the mandible originates from the cranial neural crest, the bones of the limbs are of mesodermal origin [59]. Because tubular bone is formed mesenchymally, "neural crest cells (NCCs)" derive from dorsal side of the neural tube; they proliferate rapidly and migrate along predetermined, well-characterized routes into developing frontonasal plate and gill arches.…”

“…Med. 2024, 13, x FOR PEER REVIEW 7 of 11 -While the mandible originates from the cranial neural crest, the bones of the limbs are of mesodermal origin [59]. Because tubular bone is formed mesenchymally, "neural crest cells (NCCs)" derive from dorsal side of the neural tube; they proliferate rapidly and migrate along predetermined, well-characterized routes into developing frontonasal plate and gill arches.…”