Tomoo Sonoyama

Clinical Usefulness of Mandibular Reconstruction Using Custom-Made Titanium Mesh Tray and Autogenous Particulate Cancellous Bone and Marrow Harvested From Tibia and/or Ilia.

Abstract The objective of this study was to evaluate usefulness of mandibular reconstructions using custom-made titanium mesh (Ti-mesh) tray and particulate cancellous bone and marrow (PCBM). Consecutive 21 patients who underwent mandibular reconstruction were enrolled in this study. They were 13 men and 8 women (mean age, 52.0 years). Virtual reality simulation was performed using computer software based on the preoperative computed tomography data. A 3-dimensional skull model was constructed using 3-dimensional printer. A tray was custom-made from Ti-mesh sheet bent to adapt to the model. After PCBM harvesting from posterior ilia and/or proximal tibia, the tray was fixed to the host bone. New bone formation and configuration of the reconstructed mandible were assessed radiologically. Complications were recorded in each patient during the follow-up period. Patients’ satisfaction with postoperative facial contour was evaluated using visual analog scale (VAS score, range, 0–100). In 16 of 21 patients, excellent new bone formation was recognized and expected results were radiologically achieved. In 5 patients, new bone formation was insufficient. Causes of insufficient bone formation included postoperative infection in 2 patients, Ti-mesh tray fracture in 2 patients, and local recurrence of lower gingival cancer in 1 patient. To prevent a tray fracture, a double-layered Ti-mesh tray was useful. Mean VAS score on patients’ satisfaction was 77.1. Our results comprehensively suggest that mandibular reconstruction using custom-made Ti-mesh tray and PCBM is clinically useful.

A Unique Balloon Catheter for Maxillary Sinus Surgery

Abstract Purpose: To investigate the use of a unique balloon catheter (sinus balloon) for maxillary sinus surgery, and to compare the clinical usefulness of this catheter to the conventional gauze pack with antibiotic ointment with respect to postoperative discomfort. Patients and Methods: 195 patients, who underwent Caldwell-Luc maxillary sinus surgery using the sinus balloon catheter were compared with 24 patients who underwent the same surgery using the gauze pack. Postoperative haemorrhage with the material in the sinus and haemorrhage at removal were evaluated. For 32 patients in the sinus balloon catheter group who had previously experienced maxillary sinus surgery using the gauze pack and 24 patients in the gauze pack group, pain at removal of the material was investigated by questionnaire. Results: There was no significant difference in the rate of postoperative haemorrhage between the 2 groups. The rates of haemorrhage and subjective pain level at removal of the material from the sinus were significantly lower for patients in the sinus balloon catheter group than for those in the gauze pack group. Twenty seven of 29 patients (93.1%) who completed the questionnaire preferred the sinus balloon catheter to the gauze pack. Conclusion: The sinus balloon catheter can reduce postoperative discomfort, and its compressive haemostatic effect is equal to that of the gauze pack. The sinus balloon is considered more clinically useful for maxillary sinus surgery than the gauze pack.