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Two z-plasty incisions and muscle repositioning. (A) Preoperative frontal view at 5 months of age. (B) Preoperative base view, with sagging of the nostril floor, furrows in the philtral column, and vermilion notches. (C) Operative view, with small z-flaps in the nostril floor and the vermilion border. (D) Orbicularis oris muscle is obtained from the central philtrum through an intra-oral incision and repositioned by way of two small z-flaps. (E) Muscle is passed through the nostril floor. (F) Muscle is passed though the vermilion z-flap and fixed over the discontinued philtral column. (G) Final view of surgery. (H) Eighteen months after surgery, frontal view. (I) Eighteen months after surgery, base view.
Source publication
Mandibular reconstruction is important for providing good functional and cosmetic results after the resection of a mandibulary segment. Reconstruction plates and titanium meshes are usually used to reconstruct the bony defects in mandible. Although their complications are well known there is not a report on the fractures of a titanium mesh after ma...
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Citations
... Onlay osseous graft protected by a titanium mesh demonstrated significantly less bone resorption compared with an onlay bone graft alone. 10 Titanium mesh is also an alternative to a (resorbable) membrane for ridge augmentation. 11 With its advantages, such as biocompatibility, corrosion resistance, and thermal effects, a titanium mesh has been proven to be useful in these indications, 12,13 and substantial bone augmentation can be achieved using the titanium construct in conjunction with bone grafting. ...
The aim of this initial case report was to provide a new protocol for the clinical application of a patient-specific titanium lattice structure (Yxoss CBR®, ReOSS, Filderstadt, Germany) for customized bone regeneration. To obtain a 3-dimensional reconstruction of a posterior mandible segment in a 61-year-old woman, a patient-specific titanium customized lattice structure was used. As graft material autogenous bone tissue mixed with xenogenic alloplastic material (Bio Oss®, Geistlich Pharma, Wolhusen, Switzerland) was obtained for reconstruction. After a healing period of 6 months, the titanium lattice structure was removed and implant placement (Camlog Screw Line, 3.8/11, Camlog, Wimsheim, Germany) was performed. A cylindrical bone specimen was collected for histological analysis. Twentyfour months after implant loading, bone graft appeared stable. The case presented shows that this new protocol represents a sufficient and innovative way to provide a successful and predictable management for rebuilding an atrophied, complex bone defect. No serious complication occurred during the period of convalescence and no graft exposure occurred. The implant could be placed as planned and diminished surgical time. Further research is needed including long term studies and longer follow-ups.
Orthopedic and dental implants replace millions of arthritic, traumatic or lost skeletal or dental structures. All orthopedic or dental implants can fail, and the central reason for failure is that metallic implants do not remodel with host tissue. Current implants rely primarily on tissue growth onto implants or an 'outside-in' strategy. This chapter discusses an 'inside-out' strategy to induce tissue ingrowth by cytokine delivery. Drug-eluting porous implants have the advantage not only of reducing bulk metal mass, but also of harboring cytokines that are programmed to release into surrounding tissue. This coupled inside-out and outside-in strategy improves bone ingrowth.
Yield and fatigue strength of pure titanium periodic plates were investigated for three different mesh designs using acoustic emission (AE) method. Simulations of tensile test were also conducted to estimate yield strength numerically and compare with experiments. By analyzing AE during deformation, it was found that the origin of multiple AE count rate peaks is due to various yielding locations inside the specimens. For fatigue experiments, AE was used to detect the time of first fracture as it corresponds to the failure of a single cell. However, the difference in time with the final fracture of the plate was not significant, especially for low stress amplitude.
The purpose of this study was to evaluate tray fit and bone quality of particulate cancellous bone and marrow (PCBM) mandibular reconstruction using custom-made bioresorbable forged composites of a raw particulate hydroxyapatite/poly-l-lactide (HA/PLLA) tray in a dog model. Mesh sheets of HA/PLLA were formed in a tray shape according to the mandible stereolithographs of 14 beagle dogs. Platelet-rich plasma (PRP) was obtained from venous blood, and PCBM was harvested from the iliac crest. Bone defects were made bilaterally on the lower borders of the mandible. The PCBM and PRP were mixed and compressed into the defects and a custom-made HA/PLLA or a manually adopted titanium tray was fixed by screws. Tray fit and bone qualities were evaluated using computed tomography, microfocus computed tomography and confocal laser scanning microscopy. In buccal side, there is no significant difference with tray fit between the HA/PLLA and the titanium type, but in lingual side, it was better in the HA/PLLA type than that of the Ti type. Bone volume fraction (BV/TV) had markedly increased on the HA/PLLA side at 12 months. In conclusion, the custom-made HA/PLLA tray was easily and accurately adapted to the mandible, and had achieved sufficient bone quality by 12 months.
The purpose of this study was to evaluate the bone quality of mandibles reconstructed with particulate cellular bone and marrow (PCBM) and platelet-rich plasma (PRP). We compared the bone mineral density (BMD) and microstructure of PCBM and PRP-reconstructed bone and normal bone in patients. Bone biopsies were taken of 11 samples of PCBM and PRP reconstructed bone and 16 samples of normal bone using a trephine bur. BMD and microstructures were assessed using microcomputed tomography. The compact bone resulting from the PCBM and PRP reconstruction was extremely thin. Analysis of the microstructures, showed statistically significant differences only in trabecular bone number and trabecular bone spaces between PCBM and PRP-reconstructed bones and normal bones. In the case of BMD, no statistical differences were found between the two groups. Lamellar structures and osteocytes were observed histologically in the trabecular bone in both groups. In conclusion, the BMD and microstructures of the cancellous bone in the PCBM and PRP-reconstructed mandibles resembled those in the normal mandibles.
Segmental mandibulectomy is a treatment option for benign and malignant neoplasms of the mandible. Although reconstructing the mandible of a patient with a missing segment is difficult, it is essential to improve the postoperative course of the patient. Mandibular reconstruction using titanium mesh is a useful technique for dental implant placement because the morphology of the mandible can be easily reproduced. However, fitting titanium mesh to the remaining mandible is not an easy task during surgery. The present report introduces a method in which a 3-dimensional skull model fabricated by means of stereolithography is prepared, based on computerized tomography (CT) scans, to construct a titanium mesh cage matching the shape of the mandible, preoperatively. Furthermore, the load-bearing area of the titanium mesh cage is reinforced by laser welding another layer of titanium mesh to reduce the incidence of metal fatigue during jaw movement.
