HEMI-MANDIBULAR RECONSTRUCTION USING RIB AND PMCB WITH BIOABSORBABLE POLY(PLLA-PGA) MESH TRAY

Kim, Chul Hwan; Kim, Hoon; Jung, Ju Eun

Abstract

Loss of mandibular continuity can occur secondary to trauma, infection, or tumor resection. The basic goal of mandibular reconstruction is to restore bony continuity, arch form, osseous bulk, acceptable facial form. During the mandibular reconstruction is considered, surgical choices of using autogenous bone are divided into non-vascularized cortico-cancellous bone block graft, vascularized transfer of a cortico-cancellous bone block, and particulate marrow and cancellous bone(PMCB) graft. The PMCB has been successfully used for the reconstruction of mandibular osseous defect since introduced by Boyne, et al. This graft transplants a great density of osteocompetent cells, and promotes an early revascularization with vascular ingrowth with their particulate nature. However, because of their particulate nature, require tray or crib for containing PMCB. The Titanium mesh and Dacron-urethane trays have been used widely for this purpose, and allogenic mandible or rib, ilium have been also used. Recently, bioabsorbable polymer material is used to surgeon for treatment of craniofacial fracture and congenital anomaly of craniofacial skeleton in the form of plate, mesh and screw. In different natures to metal material, secondary operation is unnecessary due to biological degradation and resorption in the body with timing, and it can give adequate strength during the bone healing period. and it can be contoured easily during the operation. Especially, in pediatric applications, it can diminish the possibility of growth disturbance and back-scattering effects diminished when radiation therapy applied. Recently, the literature was reported for jaw reconstruction with PMCB and bioabsorbable polymer tray with animal study. In this case, 18-years old woman, who was diagnosed as ameloblastoma, was shown hemimandibular osseous defects. We performed secondary reconstruction using PMCB from posterior ilium, and rib bone with bioabsorbable poly(PLLA-PGA) mesh as a tray, and some favorable results were obtained and we report it preliminarily, with literature reviews.