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Jaw Reconstruction

Partial resection of the maxilla (maxillectomy) and mandible is performed in patients with extensive benign or malign tumors as well as medication related and radiation induced osteonecrosis of the jaws. Reconstruction of such segmental defects is most commonly performed with autologous, microsurgically anastomosed free flaps.

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General information about Jaw Reconstruction

Mandible reconstruction with a 3-segmental fibula free flap, fixation with a patient specific titanium reconstruction plate (virtual computer-aided planning).

Bone, muscle, fascia and eventually skin with nutrifying artery and vein are transplanted  from the fibula, iliac crest or scapula to the recipient region to restore the form and function including speech, swallowing and habitual occlusion. The fixation of free flaps at the maxilla and mandible is performed with titanium plates and screws. Conventional plating systems as known from trauma surgery require intraoperative manual bending to accommodate for the anatomical specific needs which frequently results in poor implant placement precision, defines weak spots in the manually bend implants, and results in insufficient occlusal position, especially in reconstructive surgery. Hence, conventional plating was is increasingly  replaced by patient-specific solutions following preoperative virtual planning and computer-aided design/computer-aided manufacturing (CAD/CAM).

While this technique improves surgical precision, saves time and facilitates for complex reconstructions in the head and neck region, several challenges remain:

  • Metal artefacts in postoperative imaging, reducing the image quality, thus impairing the detection of recurrent tumors and assessment of bone healing
  • Need for metal removal to enable for dental rehabilitation with implants and prosthetics, since titanium is not resorbable / degradable
  • Osseous non-unions between bone transplant and mandible, resulting in mechanical overloading of the fixation system with increased risk of material failure and delaying dental and prosthetic rehabilitation
  • Soft tissue complications with plate exposure, especially in patients undergoing radiotherapy
  • Donor site morbidity, including chronic pain, sensory deficits, motor weakness and reduced range of motion

Therefore, we intend to reduce these complications and drawbacks with different research projects and translational approaches in the field of maxillofacial osteosynthesis and regenerative therapies.