Abstract
This article introduces mandibular reconstruction using a custom-made titanium mesh tray and autogenous particulate cancellous bone and marrow (PCBM) harvested from the ilia and/or tibiae, and discusses its clinical usefulness through a retrospective investigation on the clinical course of 17 patients who underwent our mandibular reconstruction.
All surgical procedures were uneventfully completed, and the mean operating time was 452 minutes. The amount of harvested PCBM for each patient was sufficient and ranged from 37 to 113 g. Although the postoperative clinical course with prosthetic treatments was generally acceptable, three patients with mandibular defect including the mentum region required repeated mandibular reconstruction using a double-layer tray, due to a postoperative local infection with much bone loss and fractures of the single-layer tray used for primary reconstruction. These repeated reconstructions were successful, and we have since used a double-layer tray in every reconstruction for mandibular defects including the mentum region, without additional tray fractures. The mean postoperative painless range of mandibular motion was 45.6 mm, and overall ability of daily life was not severely disturbed. Although the level of satisfaction with postoperative facial appearance was relatively low in a few patients because of lower lip rotation caused by anterior missing teeth or slight facial asymmetry, most patients obtained symmetrical and natural facial contours and were highly satisfied. Moreover, the mean Visual Analog Scale (VAS) for postoperative facial appearance was 79.8.
In conclusion, the present mandibular reconstruction seems to be a highly predictive and clinically useful modality.
