Biomedical Engineering Reference
In-Depth Information
2.2. Surgical procedures and follow-up
The operation was performed under general anesthetic, and the region was approached both
from the mouth and externally. The periosteum was detached with care not to damage it, and
the bone of the graft site was revealed. A trial insertion was made of the custom-made artificial
bone, and changes in the soft tissues were checked. Where fixation was then carried out, holes
for fixing were made using a surgical drill, and the artificial bone was fixed in place with
absorbable polyglycolic suture in several places. The surgical incision was closed by covering
the artificial bone with periosteum and making periosteal sutures in order to prevent any
deviation resulting from movement of the artificial bone after surgery(Saijo H et al., 2008).
3. Results
Conventional autologous grafts take several hours because the autologous bone must be
harvested and shaped, but the present procedure greatly reduced the operation time. During
surgery, there was excellent conformity between the artificial bone and the host bone, and firm
fixing was not needed. Even where comparatively large artificial bone was grafted and fixing
was necessary, no problems were encountered with fixing in several places. Furthermore, at
around 3 months after surgery, there were appearances of partial bone union between the
artificial bones and the host bone tissue in some patients. In addition, the patients showed a
high satisfaction with the facial features following surgery.
3.1. Case 1 (Fig.3)
The patient was 55 years old woman. The patient visited the clinic with a main complaint of
facial asymmetry. She was treated for cancer on the left side of her tongue approximately 20
years previously with partial resection of the tongue and segmental resection of the mandible.
The region was reconstructed with grafts of a rib and a pectoralis major musculo-cutaneous
flap. Radiation therapy was subsequently administered as after-treatment. A graft from the
left ilium was carried out 5 years later due to resorption of the first graft. Implants were
subsequently placed on the maxilla and the mandible, and dental implants were fitted, but
noticeable facial asymmetry remained.
Mandibular reconstructive surgery consisting of an artificial bone graft was carried out under
general anesthetic. The approach was made from outside the mouth, as there was a scar present
on the neck from the previous operation. The bone was detached by subperiosteal dissection
and the host bone graft site revealed, and a trial insertion of the custom-made artificial bone
was made. Improvement of the facial features was confirmed, and the artificial bone was fixed
to the host bone with 2-0 Vicryl suture. After placement of the graft, the artificial bone was
covered with part of the periosteum and the fatty layer, and the surgical wound was closed in
the usual way. Presently, at over 1 year operation, the patient is progressing and there is
improvement of the facial features. No inflammatory reaction or other abnormalities have been
found, and CT images show the position of the artificial bone to be stable with partial bone
union.
Search WWH ::
Custom Search