Evaluation of 15 mandibular reconstructions with Dumbach Titan Mesh-System and particulate cancellous bone and marrow harvested from bilateral posterior ilia.
This study reports on 15 mandibular reconstructions using the Dumbach Titan Mesh-System and particulate cancellous bone and marrow harvested from bilateral posterior ilia. All cases showed segmental defects. Eleven cases involved patients with malignant tumor. Six patients had received irradiation of 40-50 Gy. Reconstructions were performed immediately in 1 patient and secondarily in the remaining 14 patients. In 13 cases, mandibles were successfully reconstructed. Of these 13 patients, 9 reconstructions were completed without complications, whereas the other 4 cases showed complications. In 2 cases, reconstruction failed completely. Overall success rate was 87%. Statistical analysis revealed the extent of mandibular defect, but not malignancy of the original disease or radiotherapy of <or=50 Gy, as a significant factor in the occurrence of postoperative complications. Although no significant correlation was identified, cases in which mandibular continuity was lost at the time of reconstruction tended to show a higher postoperative complication rate. These results suggest that for the management of patients with malignant disease, resected mandible and soft tissue should be properly reconstructed using the metal plate and soft tissue flap at the time of cancer ablation surgery to reduce postreconstructive complications. Preoperative fabrication of the titanium mesh using a 3-dimensional skull model is expected to improve surgical outcomes.
Iino
Mitsuyoshi
M
Department of Oral-Maxillofacial Surgery, Dentistry, and Orthodontics, University of Tokyo Hospital, Tokyo, Japan. iinom-ora@h.u-tokyo.ac.jp
Fukuda
Masayuki
M
Nagai
Hirokazu
H
Hamada
Yoshiki
Y
Yamada
Hiroyuki
H
Nakaoka
Kazutoshi
K
Mori
Yoshiyuki
Y
Chikazu
Daichi
D
Saijo
Hideto
H
Seto
Ichiro
I
Ohkubo
Kazumi
K
Takato
Tsuyoshi
T
D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation; D016025:Bone Transplantation; D016371:Cranial Irradiation; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D008336:Mandibular Diseases / Q000601:surgery; D008339:Mandibular Neoplasms / Q000532:radiotherapy / Q000601:surgery; D008446:Maxillofacial Injuries / Q000601:surgery; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D010019:Osteomyelitis / Q000601:surgery; D011475:Prosthesis Failure; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D013526:Surgical Mesh; D013529:Surgical Wound Dehiscence; D013530:Surgical Wound Infection; D014025:Titanium; D017211:Treatment Failure; D055815:Young Adult
D014025:Titanium