Long-term Result of Various Maxillofacial Reconstruction Methods

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2012. November
The Ukraine
Long-term Result of Various
Maxillofacial Reconstruction
Methods
Autogenous Bone vs. Alloplastic Materials
G. Szabó
Semmelweis University
Budapest, Hungary

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Many techniques have
been employed through
the years to reconstruct
the mandible

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Reconstruction of
mandibular defects
a, Maintenance of bone integrity
b, Alloplastic material
c, Conventional bone graft
d, Living bone graft
e, Distraction osteogenesis

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Implants for
mandibular
reconstruction

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The past

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Vitalium implants

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Various reconstruction plates

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Osteosarcoma

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One year later free bone transplantation

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Five years later

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Melanoma metastasis in the central mandible

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Two weeks postop.

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Today

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Living bone graft
Osteo-musculo-cutaneous
TOMC (trapezius)
PMOMC (pectoral)
LdOMC (latissimus)
Pedicled or free flaps
Revascularized free transplant
Iliac bone
OM/OMC
Scapula
OM
Metatarsus
OM
Radialis
OMFC
Fibula
OM/OMC

29. 29. dia

Schwannoma

30. 30. dia

Iliac bone graft

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33. 33. dia

3 years later dental implants in the
transplanted bone.

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Before reconstruction

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Revascularised iliac bone graft.

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2 years later dental implants

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5 years later

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Computer Generated
Titanium Cranioplasty

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50. 50. dia

-Polytrauma 1991
(Only neurosugical treatment)
-From 1991-1998
-10 various operations on the craniomaxillofacial region

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The future
Carbon / Carbon
prosthesis?

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Carbon implants
Carbon fibres
and
Polymer matrix
Carbon fibres
and
Pyrocarbon matrix
( ~~ 50% Carbon)
Orthopedic and
Cardiac surgery
(99.99% Carbon)
Carbon / Carbon
since 20 years
New!

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Carbomedics (Centerpulse)
Carbon fibres are mixed with other synthetic materials

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Various devices of CarBulat™
implants

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Gingival tumor with mandibular
involvement (post irrad.)

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Synovial sarcoma

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One week postop.

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Postop. irradiation

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5 years later

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Ewing sarcoma in the mandible
after cytostatic treatment

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Resection and Carbon-Carbon reconstruction

75. 75. dia

2 weeks postop.

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10 years later

77. Carbulat Plate Removal and Iliac Bone Reconstruction

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End result

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Mandibular defect titanium plates fractured

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Angulus
Mentum
Missing bone

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CarBulat plate reconstruction

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Postop. Picture
good functional
and cosmetic
result

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CarBulat reconstruction
after hemimandibulectomy

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Augmentation with CarBulat
Hemifacial microsomia

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Wax-model and CarBulat plate

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Previous rib transplantation

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91. 91. dia

Investigation of the effect
of the human organism
on the structure and
morphology of the
CarBulat implant
Energy Dispersive Spectroscopy, EDS
Scanning Electron Microscope, SEM

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The removed CarBulat plate after 10 years of
function

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The original structure
of the CarBulat plate
and after 10 years
function.
Practically no change.

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Structure of the
CarBulat plate.
Larger magnification
(1600 carbon fibres in
1 mm)

95. DISTRACTION OSTEOGENESIS

96. THE HISTORY OF DISTRACTION OSTEOGENESIS

Hippocrates

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Gavril Abramovics Ilizarov
Kurgan

98. BONE HEALING

Fracture healing:
-impact (fracture)
-induction
-inflammation
-soft callus
-hard callus
-remodeling (1-1.5 years)
Fracture healig interrupted by distraction:
-osteotomy
-induction (osteotomy)
-inflammation
-soft callus
-distraction
-hard callus
-remodeling

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MANDIBULAR DISTRACTION
sceletal microgenia

100. MANDIBULAR DISTRACTION

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MANDIBULAR DISTRACTION

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MANDIBULAR DISTRACTION

103. MANDIBULAR DISTRACTION

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MANDIBULAR DISTRACTION
sceletal microgenia

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113. MIDFACE DISTRACTION

TPD

114. MIDFACE DISTRACTION

115. MIDFACE DISTRACTION

116. MIDFACE DISTRACTION