Bone reconstruction of extensive maxillomandibular defects in adults

Abstract

Reconstruction of significant maxillomandibular defects is a challenge that has been much discussed over the last few decades. Fundamental principles were developed decades ago (bone bed viability, graft immobilization). Clinical decision‐making criteria are highly relevant, including local/systemic factors and incision designs, the choice of material, grafting technique, and donor site morbidity. Stabilizing particulated grafts for defined defects—that is, via meshes or shells—might allow significant horizontal and vertical augmentation; the alternatives are onlay and inlay techniques. More significant defects might require extra orally harvested autologous bone blocks. The anterior iliac crest is often used for nonvascularized augmentation, whereas more extensive defects often require microvascular reconstruction. In those cases, the free fibula flap has become the standard of care. The development of alternatives is still ongoing (i.e., alloplastic reconstruction, zygomatic implants, obturators, distraction osteogenesis). Especially for these complex procedures, three‐dimensional planning tools enable facilitated planning and a surgical workflow.

Integrating Virtual Surgical Planning and 3D-Printed Tools with Iliac Bone Grafts for Orbital and Zygomatic Reconstruction in Hemifacial Microsomia Patients

“…Firstly, iliac cancellous bone grafts exhibit fewer adverse effects at the donor site compared with other autogenous bone sources, such as ribs. Additionally, they show fewer autoimmune reactions compared with the use of prosthetic materials [34]. Notably, Omara et al [35] compared the resorption rate of autogenous mineralized pulp matrix (MPM) with cancellous bone particles from the anterior iliac crest for the repair of an alveolar cleft, where the resorption rate in the control group was 48.91%, which was essentially the same as the bone resorption rate in this study.…”

The Perfect Timing—Immediate versus Delayed Microvascular Reconstruction of the Mandible

“…Partial or even complete flap loss significantly increases the morbidity of patients, prolongs hospital stays, and increases the cost to the health care system [ 3 ]. Large tumors involving the bone often require soft tissue and bony resection, resulting in extensive and, thus, functionally limiting hard and soft tissue defects [ 4 ]. For many years, there has been an ongoing debate about the appropriate timing for bony jaw reconstruction after tumor-ablative resection.…”

A comparative analysis of particulate bovine bone substitutes for oral regeneration: a narrative review

“…Unfortunately, the alveolar ridge undergoes continuous three-dimensional atrophy following tooth loss [ 4 ], with atrophy rates ranging from 25% within one year to 40–60% within five years of the initial bone volume [ 5 – 8 ]. Consequently, ridge preservation techniques have been established to mitigate this process within specific parameters [ 9 – 11 ].…”

“…Conversely, the drawbacks associated with autogenous bone grafts, including donor site morbidity and potential nerve injuries, are frequently documented [ 18 – 21 ]. As an alternative to autogenous grafts, bone substitutes (BS) of various origins have been developed, including allogeneic (from the same species, human), xenogeneic (from different species, such as bovine, porcine, or equine), and alloplastic (synthetic) materials [ 11 , 22 ]. Those derived from bovine sources are particularly prevalent among xenogeneic grafts, demonstrating numerous satisfactory long-term clinical outcomes [ 23 , 24 ].…”