Reconstruction After Hemimandibulectomy With a Plate and Soft-Tissue Free Flap Followed by a Titanium Mesh and Particulate Cancellous Bone and Marrow Harvested From Bilateral Posterior Ilia: A Case Report
A particulate cancellous bone and marrow (PCBM) graft combined with titanium (Ti-) mesh tray has become one of the most popular mandibular reconstruction methods. The technique has been applied to the mandibular discontinuity defects after segmental mandibulectomy. To the best of our knowledge, there are no reports on using the technique after hemimandibulectomy, during which a wide mandibular resection, including the condyle, is performed. Here, we first report a case of mandibular reconstruction after hemimandibulectomy, using a plate and soft-tissue free flap, followed by a Ti-mesh and PCBM harvested from the bilateral posterior ilia, which was successful. This case report first revealed how bone resorption occurred clinically in mandibular reconstruction using PCBM and Ti-mesh tray after hemimandibulectomy. We also revealed the high predictability of the mandibular reconstruction using PCBM and Ti-mesh tray after hemimandibulectomy. Our report also provides a guiding principle to overcome the limitation of mandibular reconstruction using PCBM and Ti-mesh tray after hemimandibulectomy. However, our manuscript has limited evidence, being a case report.
Panoramic radiograph before bone grafting. Hemiglossectomy, hemimandibulectomy, and defect reconstruction with a vascularized free anterolateral thigh flap and titanium plate that included the condyle were performed after the diagnosis of recurrent squamous cell carcinoma on the left side of the tongue.
Preparation of Titanium-mesh (Ti-mesh) tray for surgery. A Ti-mesh sheet was cut and formed according to the ideal reconstruction model with dental wax on the 3D model.
Intraoperative view after particulate cancellous bone and marrow (PCBM) grafting. The PCBM was loaded into the mesh and condensed as much as possible.
3-dimensional computerized tomographic findings 11 months after mandibular reconstruction by Ti-mesh tray and PCBM. The bone formation for dental implants from the canine to the molar tooth was adequate, although the horizontal bone resorption from the free-end side was remarkable. (A translucent image of the Ti-mesh after image processing is presented.)
A panoramic radiograph after placing the definitive prosthesis.
An intraoral view of the definitive prosthesis.
An intraoral view of the tissues surrounding the dental implants.
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