Mandibular reconstruction with cancellous bone, hydroxylapatite and titanium mesh

Area of Science:

• Oral and Maxillofacial Surgery
• Biomaterials Science
• Regenerative Medicine

Background:

• Mandibular discontinuity defects pose significant reconstructive challenges.
• Titanium mesh combined with autologous iliac crest spongiosa and hydroxylapatite is a common reconstructive approach.
• The influence of transplant bed quality, particularly in irradiated patients, requires further investigation.

Purpose of the Study:

• To evaluate the long-term efficacy of titanium mesh combined with autologous iliac crest spongiosa and hydroxylapatite for mandibular reconstruction.
• To assess the impact of radiation and transplant bed quality on reconstructive outcomes.
• To identify key factors influencing the success of mandibular reconstruction.

Main Methods:

• Retrospective analysis of 79 patients undergoing mandibular reconstruction over 20 years.
• Utilized titanium mesh, autologous iliac crest spongiosa, and hydroxylapatite.
• Compared outcomes between irradiated (n=14) and non-irradiated (n=65) patient groups.

Main Results:

• Successful mandibular reconstruction was observed in the majority of patients.
• Irradiated patients with compromised transplant beds experienced significantly higher complication and failure rates.
• A well-vascularized transplant bed was identified as crucial for successful reconstruction.

Conclusions:

• Titanium mesh combined with autologous bone grafts and hydroxylapatite is a reliable method for mandibular reconstruction.
• Radiation therapy negatively impacts reconstructive outcomes by compromising the transplant bed.
• Optimizing vascularity of the transplant bed is paramount for achieving successful mandibular reconstruction.