Reconstruction of mandible

In a new study, researchers describe a man whose jaw was successfully reconstructed using a bone that was grown from scratch under the muscles in his back. The benefit of this approach is that doctors don't need to remove bone from elsewhere in the body in order to create the new jawbone. The case, which is reported in The Lancet, involved a 56-year-old man who lost a substantial portion of his jawbone, also called the mandible, during cancer surgery. After 9 years of eating only soft food and soup, the patient asked the researchers to reconstruct his mandible. Dr. Patrick H. Warnke, from the University of Kiel in Germany, and colleagues began the reconstruction by taking three-dimensional CT images of the man's mandible. Using computer-aided design techniques, the team created an image of what the replacement bone graft should look like. This "virtual" replacement was then used to construct a matching metal cage. The researchers filled this cage with bone mineral blocks, a bone-inducing chemical called BMP7, and some of the patient's bone marrow. Next, the cage was implanted in a back muscle called the latissimus dorsi to allow real bone to form inside the metal mold. After 7 weeks in the patient's back, the cage was removed and the bone that had formed was used to rebuild the mandible, informs Reuters. According to Guardian Unlimited, a man has enjoyed his first real dinner in nine years after a pioneering operation to rebuild his jaw using an artifical bone grown in one of the muscles of his back. German scientists today reveal the success of a bio engineering feat that enabled the patient to sit down to sausages and bread instead of soup for the first time since his lower mandible was removed because of cancer. In the Lancet medical journal, they say the man's jaw could not otherwise have been restored without taking bone from his leg, which would have done him serious damage. The surgical team is delighted with the progress of the 54-year-old and already have more candidates on their books. Patrick Warnke, of the department of oral and maxillofacial surgery at the University of Kiel, and colleagues designed a titanium wire mesh cage to the mandible's size and shape. They filled it with bone mineral blocks as well as human bone protein and some of the patient's own stem cells. The mesh frame was inserted into the muscle below the right shoulder blade. In seven weeks, there had been sufficient bone regeneration to remove the graft and transplant it into the man's jaw. Bread and sausage never tasted so good for a German man as he chewed into his first proper meal in nine years after pioneering surgery to rebuild his jaw. The bratwurst sandwich marked the end of a grim era for the 56-year-old man, who had only been able to slurp soft food and soup since part of his jaw bone was removed because of cancer. In a procedure previously tried only on animals, University of Kiel researchers, using a growth chemical and the patient's bone marrow, containing stem cells, 'grew' a replacement jaw bone in a muscle in his right shoulder. They then grafted it into the gap left by the cancer surgery. Nine weeks after the operation, the patient can now eat steak - if it is cut up into small pieces, according to a report in the medical journal The Lancet. The man said he now wants teeth implanted so he can eat his steak before it gets cold, published The Straits Times.

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