Objective： To evaluates mandible reconstruction by free vascularized fibular flap with special emphasis on the immediate complications. Methods：The clinical data of 63 patients were reviewed, 35 male and 28 female（...Objective： To evaluates mandible reconstruction by free vascularized fibular flap with special emphasis on the immediate complications. Methods：The clinical data of 63 patients were reviewed, 35 male and 28 female（age range 16 to 73 years）. Aesthetic and functional outcomes were evaluated by follow-up and/or telephone conversation. Results：Among the 63 fibular flaps, 29 were osteocutaneous flaps with one or two skin islands. All the flaps were surviving well and the success rate was 100%. Long term donor site disability was not recorded for any patient. Thirty-one patients responded for aesthetic and functional evaluation, 20 cases（64.5%） reported their facial appearance as excellent or good, 11 （35.48%） felt fair; 14 cases （45%） could eat unrestricted diet, 17（55%） could eat soft diet; 21 cases were（67.67%） speech normal, 10（22.33%） speech intelligible. Conclusion：Free fibular flap reflects good functional and esthetic results with a high degree of consistency, and acceptable level of complications, and we strongly believe the vascularized fibular flap is the first choice for mandibular reconstruction.展开更多
Early efforts at mandibular reconstruction are described from ancient China and the Etruscans to even Hippocrates, involving wooden, terracotta and metal prostheses attached to bone or teeth. Since then, modem surgery...Early efforts at mandibular reconstruction are described from ancient China and the Etruscans to even Hippocrates, involving wooden, terracotta and metal prostheses attached to bone or teeth. Since then, modem surgery has developed more effective techniques, including no vascularized bone grafts, better alloplastic materials, vascularized loco regional grafts, soft and hard tissue compounds, bone fixation and stretching materials, and mechanisms for study models. These components have become indispensable in the surgeon＇s arsenal with regard to reconstructive surgery. A gold standard for mandibular bone reconstruction is the use of autogenous grafts. The objective of this study was to describe a clinical case of mandibular reconstruction with autogenous graft associated with adjuvant hyperbaric oxygen therapy. The clinical case presented shows the treatment performed for after-effects correction due to the non-consolidation of sagittal mandibular osteotomy performed for correction of standard III dentofacial deformity, resulting in a pseudoarthrosis with bite deviation and facial asymmetry. As a treatment plan, mandibular reconstruction was instituted with autogenous graft of anterior iliac crest associated with the use prototyping biomodel and hyperbaric oxygen therapy. After a control of 1 year and 6 months, no signs of recurrence were identified and the radiographic image showed excellent positioning, good volume and maintenance of the mandibular contour.展开更多
Currently, the gold standard for aesthetic and functional reconstruction of critical mandibular defects is an autologous fibular flap;however, this carries risk of donor site morbidity, and is not a promising option i...Currently, the gold standard for aesthetic and functional reconstruction of critical mandibular defects is an autologous fibular flap;however, this carries risk of donor site morbidity, and is not a promising option in patients with depleted donor sites due to previous surgeries. Tissue engineering presents a potential solution in the design of a biomimetic scaffold that must be osteoconductive, osteoinductive, and support osseointegration. These osteogenesis-inducing scaffolds are most successful when they mimic and interact with the surrounding native macro- and micro-environment of the mandible. This is accomplished via the regeneration triad: (1) a biomimetic, bioactive osteointegrative scaffold, most likely a resorbable composite of collagen or a synthetic polymer with collagen-like properties combined with beta-tri calcium phosphate that is 3D printed according to defect morphology;(2) growth factor, most frequently bone morphogenic protein 2 (BMP-2);and (3) stem cells, most commonly bone marrow mesenchymal stem cells. Novel techniques for scaffold modification include the use of nano-hydroxyapatite, or combining a vector with a biomaterial to create a gene activated matrix that produces proteins of interest (typically BMP-2) to support osteogenesis. Here, we review the current literature in tissue engineering in order to discuss the success of varying use and combinations of scaffolding materials (i.e., ceramics, biological polymers, and synthetic polymers) with stem cells and growth factors, and will examine their success in vitro and in vivo to induce and guide osteogenesis in mandibular defects.展开更多
Ameloblastic fibro-odontosarcoma(AFOS)now designated as odontogenic sarcoma is an extremely rare odontogenic tumor,which histologically presents as a biphasic neoplasm with a malignant mesenchymal component plus amelo...Ameloblastic fibro-odontosarcoma(AFOS)now designated as odontogenic sarcoma is an extremely rare odontogenic tumor,which histologically presents as a biphasic neoplasm with a malignant mesenchymal component plus ameloblastic epithelium.Here we report a 27-year-old Chinese female with the complaint of a painful swelling for half a month in the right mandible.A segmental mandibulectomy,with an immediate mandibular reconstruction using a free vascularized osteocutaneous fibular flap was performed using surgical guide models.Histological analysis revealed a primary odontogenic sarcoma.The postoperative period was uneventful,and no clinical indication of recurrence or metastasis was observed during the 3-year follow-up.No adjuvant therapy was proposed.This is the first odontogenic sarcoma case reported in China after the new World Health Organization classification of odontogenic lesions.展开更多
Large-size mandible graft has huge needs in clinic caused by infection,tumor,congenital deformity,bone trauma and so on.However,the reconstruction of large-size mandible defect is challenged due to its complex anatomi...Large-size mandible graft has huge needs in clinic caused by infection,tumor,congenital deformity,bone trauma and so on.However,the reconstruction of large-size mandible defect is challenged due to its complex anatomical structure and large-range bone injury.The design and fabrication of porous implants with large segments and specific shapes matching the native mandible remain a considerable challenge.Herein,the 6%Mg-doped calcium silicate(CSi-Mg6)andβ-andα-tricalcium phosphate(β-TCP,α-TCP)bioceramics were fabricated by digital light processing as the porous scaffolds of over 50%in porosity,while the titanium mesh was fabricated by selective laser melting.The mechanical tests showed that the initial flexible/compressive resistance of CSi-Mg6 scaffolds was markedly higher than that ofβ-TCP andα-TCP scaffolds.Cell experiments showed that these materials all had good biocompatibility,while CSi-Mg6 significantly promoted cell proliferation.In the rabbit critically sized mandible bone defects(∼13 mm in length)filled with porous bioceramic scaffolds,the titanium meshes and titanium nails were acted as fixation and load bearing.The results showed that the defects were kept during the observation period in the blank(control)group;in contrast,the osteogenic capability was significantly enhanced in the CSi-Mg6 andα-TCP groups in comparison with theβ-TCP group,and these two groups not only had significantly increased new bone formation but also had thicker trabecular and smaller trabecular spacing.Besides,the CSi-Mg6 andα-TCP groups showed appreciable material biodegradation in the later stage(from 8 to 12 weeks)in comparison with theβ-TCP scaffolds while the CSi-Mg6 group showed much outstanding mechanical capacity in vivo in the early stage compared to theβ-TCP andα-TCP groups.Totally,these findings suggest that the combination of customized strength-strong bioactive CSi-Mg6 scaffolds together with titanium meshes is a promising way for repairing the large-size load-bearing mandible defects.展开更多
Modern face transplant techniques have advanced to allow for the transfer of vascularized skeletal components in addition to overlying soft tissue.This represents significant opportunity for individuals with mandibula...Modern face transplant techniques have advanced to allow for the transfer of vascularized skeletal components in addition to overlying soft tissue.This represents significant opportunity for individuals with mandibular defects that are not amenable to traditional reconstruction.Care must be taken when planning and executing transplants with these complex grafts,as satisfactory functional and aesthetic outcomes rely on achieving proper spatial relationships between the mandible,skull base,and midface.Which donor skeletal elements are included in the allograft and how they are harvested are important considerations in this planning and are associated with controversy.To optimize outcomes in the reconstruction of single-jaw defects,some advocate for transplantation of only the affected jaw while others support bimaxillary transplantation.Clinical evidence in this debate is not conclusive at this time.In current practice,including donor dentoalveolar anatomy by utilizing a bilateral sagittal split osteotomy of the mandible is favored to optimize outcomes such as dental occlusion.It has been suggested that harvesting the mandible at the level of the condyle or even the temporal bone may also be possible and may improve temporomandibular joint-related outcomes.Despite encouraging preclinical evidence,these strategies remain controversial.After allograft design,successful mandibular reconstruction with face transplantation relies on surgical precision in the donor and recipient procedures.Computerized surgical planning,computer-aided design and manufacturing,and intraoperative navigation are technologies currently in use to mitigate operative complexity.Results in both cadaveric and clinical face transplantations suggest these technologies are reliable and beneficial,although some room for improvement remains.展开更多
Hemifacial microsomia and Goldenhar syndrome pose unique challenges to the craniofacial surgeon.The O.M.E.N.S.classification provides a description of the craniofacial features.For the“M”of O.M.E.N.S.(the mandible),...Hemifacial microsomia and Goldenhar syndrome pose unique challenges to the craniofacial surgeon.The O.M.E.N.S.classification provides a description of the craniofacial features.For the“M”of O.M.E.N.S.(the mandible),the Pruzansky-Kaban classification provides therapeutic guidelines for joint and face reconstruction.A sequence of standard procedures,including temporomandibular joint reconstruction,facial rotation surgery,gluteal fat grafting,and patient-specific titanium implantation,each have their intricacies.The author provides his expert opinion,acquired over thirty years of experience,with an emphasis on descriptions of and solutions for ten problematic issues.展开更多
基金Science Fund of Department of Public Health of Jiangsu Province(ZK200209)
文摘Objective： To evaluates mandible reconstruction by free vascularized fibular flap with special emphasis on the immediate complications. Methods：The clinical data of 63 patients were reviewed, 35 male and 28 female（age range 16 to 73 years）. Aesthetic and functional outcomes were evaluated by follow-up and/or telephone conversation. Results：Among the 63 fibular flaps, 29 were osteocutaneous flaps with one or two skin islands. All the flaps were surviving well and the success rate was 100%. Long term donor site disability was not recorded for any patient. Thirty-one patients responded for aesthetic and functional evaluation, 20 cases（64.5%） reported their facial appearance as excellent or good, 11 （35.48%） felt fair; 14 cases （45%） could eat unrestricted diet, 17（55%） could eat soft diet; 21 cases were（67.67%） speech normal, 10（22.33%） speech intelligible. Conclusion：Free fibular flap reflects good functional and esthetic results with a high degree of consistency, and acceptable level of complications, and we strongly believe the vascularized fibular flap is the first choice for mandibular reconstruction.
文摘Early efforts at mandibular reconstruction are described from ancient China and the Etruscans to even Hippocrates, involving wooden, terracotta and metal prostheses attached to bone or teeth. Since then, modem surgery has developed more effective techniques, including no vascularized bone grafts, better alloplastic materials, vascularized loco regional grafts, soft and hard tissue compounds, bone fixation and stretching materials, and mechanisms for study models. These components have become indispensable in the surgeon＇s arsenal with regard to reconstructive surgery. A gold standard for mandibular bone reconstruction is the use of autogenous grafts. The objective of this study was to describe a clinical case of mandibular reconstruction with autogenous graft associated with adjuvant hyperbaric oxygen therapy. The clinical case presented shows the treatment performed for after-effects correction due to the non-consolidation of sagittal mandibular osteotomy performed for correction of standard III dentofacial deformity, resulting in a pseudoarthrosis with bite deviation and facial asymmetry. As a treatment plan, mandibular reconstruction was instituted with autogenous graft of anterior iliac crest associated with the use prototyping biomodel and hyperbaric oxygen therapy. After a control of 1 year and 6 months, no signs of recurrence were identified and the radiographic image showed excellent positioning, good volume and maintenance of the mandibular contour.
文摘Currently, the gold standard for aesthetic and functional reconstruction of critical mandibular defects is an autologous fibular flap;however, this carries risk of donor site morbidity, and is not a promising option in patients with depleted donor sites due to previous surgeries. Tissue engineering presents a potential solution in the design of a biomimetic scaffold that must be osteoconductive, osteoinductive, and support osseointegration. These osteogenesis-inducing scaffolds are most successful when they mimic and interact with the surrounding native macro- and micro-environment of the mandible. This is accomplished via the regeneration triad: (1) a biomimetic, bioactive osteointegrative scaffold, most likely a resorbable composite of collagen or a synthetic polymer with collagen-like properties combined with beta-tri calcium phosphate that is 3D printed according to defect morphology;(2) growth factor, most frequently bone morphogenic protein 2 (BMP-2);and (3) stem cells, most commonly bone marrow mesenchymal stem cells. Novel techniques for scaffold modification include the use of nano-hydroxyapatite, or combining a vector with a biomaterial to create a gene activated matrix that produces proteins of interest (typically BMP-2) to support osteogenesis. Here, we review the current literature in tissue engineering in order to discuss the success of varying use and combinations of scaffolding materials (i.e., ceramics, biological polymers, and synthetic polymers) with stem cells and growth factors, and will examine their success in vitro and in vivo to induce and guide osteogenesis in mandibular defects.
基金the Priority Academic Program Development of Jiangsu Higher Education Institutions(Grant No.PAPD-2018-87)the Jiangsu Provincial Medical Key Talent Project(Grant No.ZDRCA2016087)。
文摘Ameloblastic fibro-odontosarcoma(AFOS)now designated as odontogenic sarcoma is an extremely rare odontogenic tumor,which histologically presents as a biphasic neoplasm with a malignant mesenchymal component plus ameloblastic epithelium.Here we report a 27-year-old Chinese female with the complaint of a painful swelling for half a month in the right mandible.A segmental mandibulectomy,with an immediate mandibular reconstruction using a free vascularized osteocutaneous fibular flap was performed using surgical guide models.Histological analysis revealed a primary odontogenic sarcoma.The postoperative period was uneventful,and no clinical indication of recurrence or metastasis was observed during the 3-year follow-up.No adjuvant therapy was proposed.This is the first odontogenic sarcoma case reported in China after the new World Health Organization classification of odontogenic lesions.
基金supported by the National Key Research and Development Program of China(2017YFE0117700 and 2018YFA0703000)the Science and Technology Department of Zhejiang Province Foundation(LGF20H140008 and GF22E038891)National Natural Science Foundation of China(81871775 and 81902225).
文摘Large-size mandible graft has huge needs in clinic caused by infection,tumor,congenital deformity,bone trauma and so on.However,the reconstruction of large-size mandible defect is challenged due to its complex anatomical structure and large-range bone injury.The design and fabrication of porous implants with large segments and specific shapes matching the native mandible remain a considerable challenge.Herein,the 6%Mg-doped calcium silicate(CSi-Mg6)andβ-andα-tricalcium phosphate(β-TCP,α-TCP)bioceramics were fabricated by digital light processing as the porous scaffolds of over 50%in porosity,while the titanium mesh was fabricated by selective laser melting.The mechanical tests showed that the initial flexible/compressive resistance of CSi-Mg6 scaffolds was markedly higher than that ofβ-TCP andα-TCP scaffolds.Cell experiments showed that these materials all had good biocompatibility,while CSi-Mg6 significantly promoted cell proliferation.In the rabbit critically sized mandible bone defects(∼13 mm in length)filled with porous bioceramic scaffolds,the titanium meshes and titanium nails were acted as fixation and load bearing.The results showed that the defects were kept during the observation period in the blank(control)group;in contrast,the osteogenic capability was significantly enhanced in the CSi-Mg6 andα-TCP groups in comparison with theβ-TCP group,and these two groups not only had significantly increased new bone formation but also had thicker trabecular and smaller trabecular spacing.Besides,the CSi-Mg6 andα-TCP groups showed appreciable material biodegradation in the later stage(from 8 to 12 weeks)in comparison with theβ-TCP scaffolds while the CSi-Mg6 group showed much outstanding mechanical capacity in vivo in the early stage compared to theβ-TCP andα-TCP groups.Totally,these findings suggest that the combination of customized strength-strong bioactive CSi-Mg6 scaffolds together with titanium meshes is a promising way for repairing the large-size load-bearing mandible defects.
文摘Modern face transplant techniques have advanced to allow for the transfer of vascularized skeletal components in addition to overlying soft tissue.This represents significant opportunity for individuals with mandibular defects that are not amenable to traditional reconstruction.Care must be taken when planning and executing transplants with these complex grafts,as satisfactory functional and aesthetic outcomes rely on achieving proper spatial relationships between the mandible,skull base,and midface.Which donor skeletal elements are included in the allograft and how they are harvested are important considerations in this planning and are associated with controversy.To optimize outcomes in the reconstruction of single-jaw defects,some advocate for transplantation of only the affected jaw while others support bimaxillary transplantation.Clinical evidence in this debate is not conclusive at this time.In current practice,including donor dentoalveolar anatomy by utilizing a bilateral sagittal split osteotomy of the mandible is favored to optimize outcomes such as dental occlusion.It has been suggested that harvesting the mandible at the level of the condyle or even the temporal bone may also be possible and may improve temporomandibular joint-related outcomes.Despite encouraging preclinical evidence,these strategies remain controversial.After allograft design,successful mandibular reconstruction with face transplantation relies on surgical precision in the donor and recipient procedures.Computerized surgical planning,computer-aided design and manufacturing,and intraoperative navigation are technologies currently in use to mitigate operative complexity.Results in both cadaveric and clinical face transplantations suggest these technologies are reliable and beneficial,although some room for improvement remains.
文摘Hemifacial microsomia and Goldenhar syndrome pose unique challenges to the craniofacial surgeon.The O.M.E.N.S.classification provides a description of the craniofacial features.For the“M”of O.M.E.N.S.(the mandible),the Pruzansky-Kaban classification provides therapeutic guidelines for joint and face reconstruction.A sequence of standard procedures,including temporomandibular joint reconstruction,facial rotation surgery,gluteal fat grafting,and patient-specific titanium implantation,each have their intricacies.The author provides his expert opinion,acquired over thirty years of experience,with an emphasis on descriptions of and solutions for ten problematic issues.
