5.Methodology: workflow for virtual reposition of mandibular condyle fractures
Jan MATSCHKE ; Adrian FRANKE ; Olufunmi FRANKE ; Christian BRÄUER ; Henry LEONHARDT
Maxillofacial Plastic and Reconstructive Surgery 2023;45(1):5-
Background:
Even though mandibular condyle fractures have a high clinical relevance, their treatment remains somewhat challenging. Open reduction and internal fixation are difficult due to narrow surgical approaches, poor overview during reduction, and a possible risk of facial nerve damage. In times of technical endeavors in surgery, there is a trend towards the usage of stable CAD-CAM-implants from additive manufacturing or titanium laser sintering. Up until now, there have not been any reports of fracture treatment of the mandibular condyle using this technique.
Results
and conclusion We present a workflow for virtual repositioning of the fractured mandibular condyle, to manufacture patient-specific implants for osteosynthesis with the intention of use of resorbable metal alloys in the future.
6.Nanomedicine and nanoparticle‑based delivery systems in plastic and reconstructive surgery
Jea Giezl N. SOLIDUM ; Jeremy A. CERIALES ; Erika P. ONG ; Eric David B. ORNOS ; Ruth Joy L. RELADOR ; Elgin Paul B. QUEBRAL ; Jose Florencio F. LAPEÑA JR. ; Ourlad Alzeus G. TANTENGCO ; Ka Yiu LEE
Maxillofacial Plastic and Reconstructive Surgery 2023;45(1):15-
Background:
Nanotechnology and nanomedicine are rising novel fields in plastic and reconstructive surgery (PRS).The use of nanomaterials often goes with regenerative medicine. Due to their nanoscale, these materials stimulate repair at the cellular and molecular levels. Nanomaterials may be placed as components of nanocomposite polymers allowing enhancement of overall biochemical and biomechanical properties with improved scaffold properties, cellular attachment, and tissue regeneration. They may also be formulated as nanoparticle-based delivery systems for controlled release of signal factors or antimicrobials, for example. However, more studies on nanoparticle-based delivery systems still need to be done in this field. Nanomaterials are also used as frameworks for nerves, tendons, and other soft tissues.Main body In this mini-review, we focus on nanoparticle-based delivery systems and nanoparticles targeting cells for response and regeneration in PRS. Specifically, we investigate their roles in various tissue regeneration, skin and wound healing, and infection control. Cell surface-targeted, controlled-release, and inorganic nanoparticle formulations with inherent biological properties have enabled enhanced wound healing, tumor visualization/imaging, tissue viability, and decreased infection, and graft/transplantation rejection through immunosuppression.
Conclusions
Nanomedicine is also now being applied with electronics, theranostics, and advanced bioengineering technologies. Overall, it is a promising field that can improve patient clinical outcomes in PRS.
7.Investigating the accuracy of mandibulectomy and reconstructive surgery using 3D customized implants and surgical guides in a rabbit model
Min Keun KIM ; Min Ji HAM ; Won Rae KIM ; Hyung Giun KIM ; Kwang Jun KWON ; Seong Gon KIM ; Young Wook PARK
Maxillofacial Plastic and Reconstructive Surgery 2023;45(1):8-
Background:
This study aimed to analyze the accuracy of the output of three-dimensional (3D) customized surgical guides and titanium implants in a rabbit model, and of mandibulectomy, reconstructive surgery, and surgical outcome; additionally, the correlation between surgical accuracy and surgical outcomes, including the differences in surgical outcome according to surgical accuracy, was analyzed.
Results:
The output of implants was accurately implemented within the error range (− 0.03–0.03 mm), and the surgical accuracy varied depending on the measured area (range − 0.4–1.1 mm). Regarding surgical outcomes, anglebetween the mandibular lower borders showed the most sensitive results and distance between the lingual cusps of the first molars represented the most accurate outcomes. A significant correlation was noted between surgical accuracy in the anteroposterior length of the upper borders pre- and postoperatively and the angle between themandibular lower borders (regression coefficient = 0.491, p = 0.028). In the group wherein surgery was performed more accurately, the angle between the mandibular lower borders was reproduced more accurately (p = 0.021). Aselective laser melting machine accurately printed the implants as designed. Considering the positive correlation among surgical accuracy in the mandibular upper borders, angle between the mandibular lower borders, and more accurately reproduced angle between the mandibular lower borders, the angle between the mandibular lower borders is considered a good indicator for evaluating the outcomes of reconstructive surgery.
Conclusion
To reduce errors in surgical outcomes, it is necessary to devise a positioner for the surgical guide and design a 3D surgical guide to constantly maintain the direction of bone resection. A fixed area considering the concept of three-point fixation should be selected for stable positioning of the implant; in some cases, bilateral cortical bone fixation should be considered. The angle between the mandibular lower borders is a sensitive indicator for evaluating the outcomes of reconstructive surgery.
8.Effects of rhBMP‑2 with various carriers on maxillofacial bone regeneration through computed tomography evaluation
Ja In SEO ; Ji Hye LIM ; Woo Min JO ; Jeong Keun LEE ; Seung Il SONG
Maxillofacial Plastic and Reconstructive Surgery 2023;45(1):40-
Background:
rhBMP-2 is regarded as the most potent osteoinductive growth factor, and it has been used in the oral cavity with different carriers. The purpose of this study is to evaluate the bone-regenerative effect of rhBMP-2 delivered with different carrier systems through three-dimensional cone beam computed tomography analysis.Method A total of 112 patients underwent oral surgery with rhBMP-2 application (Group 1, n = 53) or without rhBMP-2 application (Group 2, n = 59). Group 1 was divided into 3 groups according to carriers, rhBMP-2 with allograft (Group 1–1, n = 34), rhBMP-2 with xenograft (Group 1–2, n = 5), and rhBMP-2 with absorbable collagen sponge (Group 1–3, n = 14). Cone beam computed tomography scans were taken before surgery (T0) 6 months after surgery (T1). The volume of defects was measured through the three-dimensional image analysis tool.
Results:
The average bone regeneration rate of Group 1 was significantly greater than that of Group 2. Within Group 1, the group that used allograft as a carrier (Group 1–1) showed significantly higher bone regeneration rates than the group that used absorbable collagen sponge as a carrier (Group 1–3).
Conclusion
The use of rhBMP-2 after oral surgery results in a superior bone regeneration rate compared to not using rhBMP-2, and its efficacy depends on the carriers it is used with. Allograft affects bone regeneration more than absorbable collagen sponge when it is carried with rhBMP-2. Therefore, the appropriate use of rhBMP-2 with suitable bone grafting materials is useful for promoting postoperative bone regeneration in oral surgery.
9.The combined application of bleomycin with triamcinolone acetonide in port wine stains: inhibiting proliferation and recurrence of port wine stains
Maxillofacial Plastic and Reconstructive Surgery 2023;45(1):28-
Background:
Port wine stains slowly grow thicker over time, nodules appear on the surface, and the color slowly deepens from pink to purple. Even after laser treatment, some port wine stains will recur and slowly grow, and the erythema appears again. The purpose of this study was to investigate the effectiveness of bleomycin in com‑ bination with triamcinolone acetonide in the treatment of inhibiting the proliferation and recurrence of port wine stains.
Results:
Histopathological change: Before treatment, dense capillaries were distributed within the lesion, and blood fills the lumen. Lack of normal skin structure: After bleomycin and triamcinolone acetonide injection, the number of capillaries was significantly reduced, and fibrosis occurred in tissues. Changes in facial morphology: After treatment, the port wine stains became thinner, the asymmetry of the face was effectively improved, and the appearance have been significantly improved. After 5 years of follow-up, there were no recurrent cases.
Conclusion
Bleomycin and triamcinolone acetonide injection can effectively inhibit the proliferation of port wine stains and prevent port wine stains from recurring after treatment.
10.Ameloblastic carcinoma of the mandible:a case report
Satoru OGANE ; Arisa FUJII ; Taiki SUZUKI ; Kazuhiko HASHIMOTO ; Sadamitsu HASHIMOTO ; Masayuki TAKANO ; Akira KATAKURA ; Takeshi NOMURA
Maxillofacial Plastic and Reconstructive Surgery 2023;45(1):17-
Background:
Ameloblastic carcinoma is a malignant form of ameloblastoma and a very rare odontogenic tumor. We report a case of ameloblastic carcinoma that occurred after removal of a right-sided mandibular dental implant.Case presentation A 72-year-old female patient visited her family dentist with a complaint of pain around a lower right implant placed 37 years previously. Although the dental implant was removed with the diagnosis of periimplantitis, the patient experienced dullness of sensation in the lower lip and was followed up by her dentist, but after no improvement. She was referred to a highly specialized institution where she was diagnosed with osteomyelitis and treated the patient with medication; however, there was no improvement. In addition, granulation was observed in the same area leading to a suspicion of malignancy, and the patient was referred to our oral cancer center. The diagnosis of squamous cell carcinoma was made after a biopsy at our hospital. Under general anesthesia, the patient underwent mandibulectomy, right-sided neck dissection, free flap reconstruction with an anterolateral thigh flap, immediate reconstruction with a metal plate, and tracheostomy. Histological analysis of the resected specimen on hematoxylin and eosin staining showed structures reminiscent of enamel pulp and squamous epithelium in the center of the tumor. The tumor cells were highly atypical, with nuclear staining, hypertrophy, irregular nuclear size, and irregular nuclear shape, all of which were suggestive of cancer. Immunohistochemical analysis showed that Ki-67 was expressed in more than 80% of the targeted area, and the final diagnosis was primary ameloblastic carcinoma.
Conclusion
After reconstructive flap transplantation, occlusion was re-established using a maxillofacial prosthesis.The patient remained disease-free at the 1-year 3-month follow-up.

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