Zamiri Barbad, Shahidi Shoaleh, Eslaminejad Mohamadreza Baghaban, Khoshzaban Ahad, Gholami Mehdi, Bahramnejad Emad, Moghadasali Reza, Mardpour Soura, Aghdami Nasser
Department of Oral and Maxillofacial Surgery, Dental Faculty, Shiraz University of Medical Sciences, Shiraz, Iran.
J Craniofac Surg. 2013 Jul;24(4):1292-7. doi: 10.1097/SCS.0b013e318294288a.
Mandibular continuity defects occur after tumor resection, maxillofacial injury, or osteomyelitis. In this clinical pilot study, we report a novel method for reconstruction of mandibular continuity defect by in vivo tissue engineering. In 3 patients with critical-size mandibular bone defects, the allogenic mandibular bone scaffold was customized, loaded by ex vivo expanded mesenchymal stem cells, and transplanted into the surgical defect site. According to the bone scintigraphy, vascularized bone was identified in 2 cases. In spiral computed tomography, normal bone healing without significant bone resorption was seen at the 2 viable grafts, but at the failed construction, there was a lack of osteointegration to the adjacent host bone and a higher density in the medullary bone. According to the serial panoramic imaging, the patients with viable bone grafts had normal bone healing, whereas the other patient had progressive overall bone resorption. Our results demonstrate the feasibility of allogenic bone scaffold loaded by mesenchymal stem cells in the reconstruction of mandibular continuity defects. Although long-term results are not yet available, it may be a novel method of reconstruction and a basis for further studies.
下颌骨连续性缺损发生于肿瘤切除、颌面损伤或骨髓炎之后。在这项临床初步研究中，我们报告了一种通过体内组织工程重建下颌骨连续性缺损的新方法。在3例临界大小的下颌骨缺损患者中，定制了同种异体下颌骨支架，用体外扩增的间充质干细胞进行加载，然后移植到手术缺损部位。根据骨闪烁显像，2例发现有血管化骨。在螺旋计算机断层扫描中，2个存活移植物可见正常骨愈合且无明显骨吸收，但在失败的构建中，与相邻宿主骨缺乏骨整合且髓质骨密度较高。根据系列全景成像，有存活骨移植物的患者骨愈合正常，而另一名患者则出现进行性整体骨吸收。我们的结果证明了间充质干细胞加载的同种异体骨支架在重建下颌骨连续性缺损中的可行性。虽然尚无长期结果，但它可能是一种新的重建方法和进一步研究的基础。
