Mandibular reconstruction using custom-made titanium mesh tray and particulate cancellous bone and marrow harvested from bilateral posterior ilia

Abstract

The objective of this study is to evaluate usefulness of mandibular reconstructions using a custom-made titanium mesh (Ti-mesh) tray and particulate cancellous bone and marrow (PCBM). A consecutive nine patients who underwent mandibular reconstruction were enrolled in this study. They were five men and four women (mean age: 53.9 years). Virtual reality simulation was performed using computer software based on the pre-operative computed tomography data. A 3-dimensional (3-D) skull model was constructed using a 3-D printer. A tray was custom-made from a Ti-mesh sheet bent to adapt to the model. After PCBM harvesting from bilateral posterior ilia, the tray was fixed to the host bone. New bone formation and configuration of the reconstructed mandible were assessed radiologically. Complications were recorded in each patient during the follow-up period. Patients, satisfaction with post-operative facial contour was evaluated using a visual analogue scale (VAS score, range = 0-100). In six of nine patients, excellent new bone formation was recognised and expected results were radiologically achieved. Complications occurred in four patients. These complications included Ti-mesh fracture, Ti-mesh exposure in the oral cavity, and delayed infection. Mean VAS score on patient satisfaction was 77.6. Although the data are preliminary, the results suggest that this method is clinically useful.

Immediate mandibular reconstruction via patient‐specific titanium mesh tray using electron beam melting/CAD/rapid prototyping techniques: One‐year follow‐up

“…CAD/CAM techniques and virtual planning methods provided the surgeons with a virtual environment for preoperative planning, reduced the surgical procedure time and related costs and yielded enhanced precision in restoring facial symmetry . Several complications were reported using pre‐adapted titanium meshes on a skull model, including a difficult and time‐consuming bending technique and fracture of the titanium mesh due to decreased strength and increased flexibility with insufficient bone formation as a result of mobilization of the bone graft . The EBM patient‐specific titanium tray showed satisfactory results in providing a symmetrical facial appearance and contours postoperatively, decreased intra‐operative time, ease in fixation, excellent adaptation on the remaining bony segments with the aid of the mandibular resection template, maintenance of proper condylar positioning and occlusion, and finally a cost comparable to that of the conventional reconstruction plate.…”

“…A titanium mesh tray and the Dacron urethane tray are the most frequently used . However, their strength is not suitable for reconstruction of the mandibular discontinuity; thus, long‐term maxillo‐mandibular fixation or reinforcement with a reconstruction plate is needed to prevent fracture of the mesh/tray, especially in long span defects including the chin area …”

Computer-Assisted Surgery for Mandibular Reconstruction Using a Patient-Specific Titanium Mesh Tray and Particulate Cancellous Bone and Marrow

“…This method has major advantages over the conventional bending technique with respect to the mechanical strength of the titanium mesh tray, thus preventing titanium mesh fracture. To avoid this serious complication, Yamada et al [11] reported that combination repair with a titanium reconstruction plate or fabrication of a reinforced titanium mesh tray (e.g. double layered titanium mesh) was necessary for the cases of long-span defect of the mandible.…”

“…Defects of the mandible caused by tumor, osteomyelitis, or severe trauma affect patients' quality of life both physiologically and psychologically. Various approaches for mandibular reconstruction, including reconstructive titanium plates, nonvascularized or vascularized bone grafts, and autogenous iliac bone grafts in combination with a ready-made titanium mesh trays, have been tried [10] [11]. The most common approach for mandibular reconstruction today is a vascularized-bone graft from the fibula and iliac crest [6]- [8].…”

Design of a Patient Specific, 3D printed Arm Cast

“…Applying these concepts, the medical industry has been mentioned in papers such as (Otawa et al 2015;Sutradhar et al 2014;Yamada et al 2014) however the collaborative design is something that hasn't been taken into the mass customization conceptual space mainly the speed of converting medical imaging data to usable CAD file for use in additive manufacturing. With the use of 3D scanning and increased software and 3D printing capabilities, these concepts can be applied.…”