チタンメッシュと両側後腸骨稜より採取した海綿骨細片による下顎骨再建

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  • Mandibular reconstruction of large bone defects by using titanium mesh and particulate cancellous bone and marrow harvested from bilateral posterior iliac crests

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Iliac particulate cancellous bone and marrow (PCBM) grafts combined with titanium mesh have been one of the most common surgical procedures for the repair of large mandibular discontinuity. From the anterior ilium which is the most common donor site, however, harvesting a proper amount of PCBM for a large mandibular defect is sometimes difficult. On the other hand, it is well known that the poste riorilium is an excellent donor source for sufficient volume of PCBM.<BR>During the past three years, large discontinuity defects of the mandible were reconstructed in 7 patients with PCBM from the bilateral posterior hip combined with titanium mesh. The reconstruction surgeries were carried out immediately in one patient and secondarily in 6 patients. Causes of mandibular defects were malignant tumor in 5 patients, and trauma and osteomyelitis in one patient respectively. Four patients with malignant tumor underwent radiotherapy prior to the mandibular reconstruction.<BR>During the surgery, a sufficient amount of PCBM was easily and quickly harvested from the bilateral posterior ilium in all cases. There was no serious postoperative complication related to the surgery. Satisfactory mandibular forms were obtained in all 7 patients. Excellent dental rehabilitation was com pletedwith the use of endosseous implants into the reconstructed mandible in 4 patients.<BR>In conclusion, reconstruction of the large mandibular defects by using titanium mesh and PCBM from bilateral posterior iliac crests is considered to be a highly useful surgical management.

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