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Maxillary reconstruction using tunneling flap technique with 3D custom-made titanium mesh plate and particulate cancellous bone and marrow graft: a case report

 ( Takano Masayuki ) - Tokyo Dental College Department of Oral and Maxillofacial Surgery

 ( Sugahara Keisuke ) - Tokyo Dental College Department of Oral Pathobiological Science and Surgery
 ( Koyachi Masahide ) - Tokyo Dental College Department of Oral Pathobiological Science and Surgery
 ( Odaka Kento ) - Tokyo Dental College Department of Oral and Maxillofacial Radiology
 ( Matsunaga Satoru ) - Tokyo Dental College Oral Health Science Center
 ( Homma Shinya ) - Tokyo Dental College Department of Oral and Maxillofacial Implantology
 ( Abe Shinichi ) - Tokyo Dental College Department of Anatomy
 ( Katakura Akira ) - Tokyo Dental College Department of Oral Pathobiological Science and Surgery
 ( Shibahara Takahiko ) - Tokyo Dental College Department of Oral and Maxillofacial Surgery

Abstract


Background: Reconstructive surgery is often required for tumors of the oral and maxillofacial region, irrespective of whether they are benign or malignant, the area involved, and the tumor size. Recently, three-dimensional (3D) models are increasingly used in reconstructive surgery. However, these models have rarely been adapted for the fabrication of custom-made reconstruction materials. In this report, we present a case of maxillary reconstruction using a laboratory-engineered, custom-made mesh plate from a 3D model.

Case presentation: The patient was a 56-year-old female, who had undergone maxillary resection in 2011 for intraoral squamous cell carcinoma that presented as a swelling of the anterior maxillary gingiva. Five years later, there was no recurrence of the malignant tumor and a maxillary reconstruction was planned. Computed tomography (CT) revealed a large bony defect in the dental-alveolar area of the anterior maxilla. Using the CT data, a 3D model of the maxilla was prepared, and the site of reconstruction determined. A custom-made mesh plate was fabricated using the 3D model (Okada Medical Supply, Tokyo, Japan). We performed the reconstruction using the custom-made titanium mesh plate and the particulate cancellous bone and marrow graft from her iliac bone. We employed the tunneling flap technique without alveolar crest incision, to prevent surgical wound dehiscence, mesh exposure, and alveolar bone loss. Ten months later, three dental implants were inserted in the graft. Before the final crown setting, we performed a gingivoplasty with palate mucosal graft. The patient has expressed total satisfaction with both the functional and esthetic outcomes of the procedure.

Conclusion: We have successfully performed a maxillary and dental reconstruction using a custom-made, pre-bent titanium mesh plate.

키워드

Mouth neoplasms; Reconstructive surgical procedure; Three-dimensional printing; Surgical flap
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