自家脛骨骨髄海綿骨細片とカスタムメイド・チタンメッシュトレーを用いて下顎骨再建を行った1例

• Published in: 日本口腔外科学会雑誌 Vol. 65; no. 8; pp. 545 - 550
• Main Authors: 雨宮, 剛志, 濱田, 良樹, 長谷部, 充彦, 堀内, 俊克, 山田, 秀典, 中岡, 一敏
• Format: Journal Article
• Language: Japanese
• Published: 社団法人 日本口腔外科学会 20.08.2019
• Subjects: インプラント; カスタムメイド・チタンメッシュトレー; 下顎骨再建術; 脛骨; 骨髄海綿骨細片
• ISSN: 0021-5163; 2186-1579
• DOI: 10.5794/jjoms.65.545

In our department, we have performed mandibular reconstruction using autogenous particulate cancellous bone and marrow (PCBM) harvested from the posterior iliac crest and a custom-made titanium mesh tray for extended mandibular defects caused by tumor resection and so on. However, harvesting PCBM from the posterior iliac crest has a disadvantage of postural changes during surgery. On the other hand, we can safely and easily harvest a sufficient quantity of PCBM from the tibia.　The patient was a 56-year-old man who underwent immediate mandibular reconstruction using PCBM harvested from the tibia and a custom-made titanium mesh tray after segmental mandibular resection for an extended odontogenic keratocyst in the right mandible. We could harvest approximately 50 g (approx. 49 mL) of PCBM from the unilateral tibia and achieve successful mandibular reconstruction with a natural configuration. Finally, the bone quality of the reconstructed mandible become good. Eleven months later, dental implant placement was performed, and the final occlusal reconstruction with a bone-anchored bridge was completed. The postoperative course has been functionally and aesthetically uneventful for 5 years after mandibular reconstruction. In addition, there were no complications, such as gait disturbance associated with PCBM harvested from the tibia.