Osteosynthetic titanium mini-plate fixation of composite radial forearm flaps in mandibular reconstruction

Three-dimensional macroporous materials for tissue engineering of craniofacial bone

Repair of critical-size defects caused by trauma, removal of a tumour, or congenital abnormalities is a challenge in the craniomaxillofacial region because of the limitations associated with treatment. We have reviewed research papers and updated information relevant to the various types of macroporous scaffolds. We have included papers on several biomaterials and their use in various craniofacial defects such as mandibular, calvarial, and others, as well as the latest technological developments such as 3-dimensional printed scaffolds. We selected all papers about scaffolds, stem cells, and growth factors for review. Initial selection was by review of titles and abstracts, and the full texts of potentially suitable articles were then assessed. Methods of tissue engineering for repair of critical-size defects in the craniofacial bones seem to be viable options for surgical treatment in the future. Macroporous scaffolds with interconnected pores are of great value in regeneration of bone in the craniofacial region. In recent years, various natural or synthetic materials, or both, have been developed, on which macroporous scaffolds can be based. In this review we present a review on the various types of three-dimensional macroporous scaffolds that have been developed in recent years, and evaluate their potential for regeneration of craniofacial bone.

Mandibular reconstruction using AO/ASIF stainless steel reconstruction plate: a retrospective study of 36 cases

AIM

The study was aimed at esthetic and functional results as well as patient tolerance after reconstruction with reconstruction plate. The follow-up ranged from 1 to 4 years.

MATERIALS AND METHODS

A retrospective study of 36 patients who had mandibular reconstruction with AO/ASIF stainless steel reconstruction plates after oncologic resection was evaluated. The indications and postoperative outcomes were studied.

RESULTS

At the end of study, 24 of 36 patients (67%) still had the plate in place. Around three (8%) plates were fractured. Nine (25%) plates got exposed leading to surgical intervention. Surgical results were satisfying, particularly when looking at delayed healing or long-term tolerance. Esthetic (79% rated results as good or acceptable) and functional results of this reconstruction were satisfying.

CONCLUSION

We conclude by saying that reconstruction plate provides a solution for safe and rapid mandibular reconstruction for patients with poor prognosis or poor condition. This method also preserves the possibility of secondary reconstruction.

CLINICAL SIGNIFICANCE

The reconstruction plate may be a good clinical choice for safe and rapid mandibular reconstruction.

Mandibular reconstruction using the titanium functionally dynamic bridging plate system: a retrospective study of 34 cases

PURPOSE

We sought to examine the use of the Titanium Functionally Dynamic Bridging Plate System (Howmedica Leibinger, Freiburg, Germany) for mandibular reconstruction after oncologic resection in 34 patients.

PATIENTS AND METHODS

A retrospective study of 34 patients who had mandibular reconstruction using the titanium dynamic bridging plate system for mandibular reconstruction after oncologic resection were evaluated. The indications and postoperative outcomes were studied. Our evaluation focuses on the tolerance and aesthetic and functional results of this system.

RESULTS

The follow-up ranged from 1 to 4 years. At the end of the study, 18 of the 34 patients (53%) still had the plate in place. One plate fracture and 1 plate exposure requiring surgical management were found. Surgical results were satisfying, particularly when looking at healing delay or long-term tolerance. Aesthetic (79% rated the results as good or acceptable) and functional results of this reconstruction material were satisfying.

CONCLUSION

This reconstruction system provides a solution for a safe and rapid mandibular reconstruction for patients with a poor prognosis or poor general condition. This method also preserves the possibility of secondary reconstruction.

Experience with freeze-dried PGLA/HA/rhBMP-2 as a bone graft substitute

We investigated bone induction by recombinant human bone morphogenetic protein-2 in rodents. The purpose of this study was to evaluate the osteoinductive potential of a resorbable bone substitute fabricated from freeze-dried poly(glycolic acid-co-lactic acid) (PGLA) mixed with hydroxyapatite particles incorporated with bone morphogenetic protein-2 in skull defects of rats (FD-PGLA/HA/rhBMP-2). The FD-PGLA/HA/rhBMP-2 composite or as a control, the FD-PGLA/HA by itself were implanted in skull defects (psi 8 mm) of rats. The samples were harvested at 2 or 4 weeks postoperatively and were studied radiographically and histologically. Four weeks after implantation, the FD-PGLA/HA/rhBMP-2 discs were completely replaced by newly-formed bone possessing bone marrow. In contrast, the defects implanted with FD-PGLA/HA were filled only with fibrous connective tissue. The results suggest that the FD-PGLA/HA/rhBMP-2 composite could be an optimum bone substitute with osteoinductive potential and could function as an alternative bone graft material for autogenous bone in humans.

Lag screw fixation of composite radial forearm grafts in the reconstruction of mandibular discontinuities

PURPOSE

This report reviews the results of immediate mandibular reconstruction performed with unosteotomized composite osteocutaneous forearm flaps using a lag screw technique for stabilization of the bone graft.

PATIENTS AND METHODS

Six patients, reconstructed as described, were followed-up for a mean period of 21 months postoperatively (range, 13 to 36 months).

RESULTS

Good initial stability was achieved, and healing was uneventful. At radiographic examination 12 months postoperatively, bony healing without dislocation of the segments was found in all patients.

CONCLUSION

The lag screw technique provides good initial stability and allows functional stresses to be transmitted to the graft.

An evaluation of the Würzburg titanium miniplate osteosynthesis system for mandibular fixation

We present an 8-year experience with the Würzburg noncompression titanium miniplate system for the rigid fixation of the mandible during elective head and neck cancer surgery in a consecutive series of 100 patients. One half of the miniplates were used to fix mandibulotomies undertaken for surgical access. The remaining half were in patients undergoing reconstruction of segmental mandibular defects, the vast majority (92%) with vascularised bone grafts. One to four variously shaped miniplates were used per patient (mean = 1.5), plate size ranging from 4 to 40 holes. Fifteen patients (15%) developed complications which included 3 mandibular osteoradionecrosis, 8 broken, 5 infected, and 4 exposed plates. Three of the eight fractured plates were associated with nonunion. In this study, the main advantages of titanium miniplate fixation, namely case of application, decreased fixation time and malleability, were accompanied by a level of morbidity which, while comparing well with alternatives, may necessitate a reappraisal of this technique of fixation.

The radial forearm flap in orofacial reconstruction

This review on the radial forearm flap deals with the multiple applications possible in orofacial reconstruction using this graft. The variations are illustrated and some salient points of the method are discussed.

Hyperbaric oxygen treatment of osteoradionecrosis of the mandible with repeated pathologic fracture. Report of a case

Treatment of patients with osteoradionecrosis of the mandible with a pathologic fracture consists in almost all cases of a continuity resection of the mandible. This leads to functional and esthetic problems that can only be solved by often extensive surgery. In this case report we present a 38-year-old woman who developed osteoradionecrosis of the mandible with a pathologic fracture 1 1/2 years after combined surgical and radiation therapy of an adenocarcinoma of the right parotid gland. The patient had a subcondylar pathologic fracture together with osteolysis in the right mandibular body, normally an indication for partial resection of the mandible. Because of the absence of denuded bone, fistulation, and the poor quality of the surrounding soft tissues, a more conservative approach was chosen. Treatment consisted of hyperbaric oxygen and dental extractions with alveolectomy with the patient under local anesthesia. During follow-up, a second pathologic fracture occurred in the region of the right first and second molar. No additional treatment was given. Six and one-half years after the initial treatment and 5 1/2 years after the last fracture, the patient is free of complaints, the fractures have healed and both esthetic and functional results are good.

Mandibular reconstruction with the Dacron urethane tray: a radiologic assessment of bone remodeling

A retrospective study was made of 22 consecutive patients who underwent mandibular reconstruction with a Dacron (Osteo-mesh, Xomed Inc, Jacksonville, FL) tray technique from September 1988 to April 1992. Free autogenous iliac bone, in the form of particulate cancellous chips and marrow, was densely packed into the Dacron tray, that was adapted to bridge the mandibular segmental defect. Sixteen cases underwent uneventful healing with the formation of a continuous bony bridge and union with the remaining mandible. The pattern of bone remodeling and rate of resorption in these cases were assessed by sequential panoramic radiographs taken up to 3 years postoperatively. The mean horizontal dimension of the mandibular defects was 75 mm and the mean vertical reconstructed height was 25 mm. When the grafted bone was radiographically of uniform density, it progressed into a mature trabecular pattern matching that of the normal mandible. However, when there were areas of radiolucency, most likely from inadequate condensation of the graft, such areas were not replaced by bone in the long term. The bony height at both ends and the middle of the reconstructed segment underwent reasonably even resorption and retained about 80% of the bony height over a 3-year period. The rate of resorption was highest in the first 6 months and stabilized at about 2 years. There were six failures, all showing significant irregular bony resorption prior to tray removal.

Fixation of vascularized bone grafts

In 24 patients, fixation of isolated or combined bone grafts has been performed exclusively with miniplates. Other than the lateral displacement of one osteomyocutaneous iliac crest graft, no complication occurred with regard to the fixation method chosen. In contrast to the clinical findings, our results of an animal experiment demonstrate less complications by fixation of vascularized bone grafts to mandibular angle defects (guinea pig) when THORP plates are used instead of miniplates. Whereas we consider miniplate fixation of vascularized bone grafts to be the method of choice, selected patients may require more stable fixation systems, especially when a high postoperative mobility may be expected or large amounts of the mandible including the condyle have to be reconstructed.