Abstract

Reconstructive surgery is the vital link to function and quality of life for patients with facial injuries, defects due to tumors, and facial differences from congenital anomalies. The past century has witnessed tremendous advances in reconstructive surgery and Oral and Maxillofacial Surgery has played a significant role in these advances. Application of technology has been a key to contemporary advances and will be for the foreseeable future. The next phase, however, will focus on the use of technology to regenerate the tissues needed for these reconstructive endeavors in hopes of improving the quality of the reconstructions while reducing morbidity and the length of hospital stays. This session will highlight these advances in reconstructive surgery, some of the hurdles on the horizon for regenerative techniques, and the promise they represent. 

Learning Objectives

• The learner will have an understanding of the impact of free tissue transfer techniques in CMF reconstruction
• The participant will gain an understanding of how new technologies have been implemented as the art of CMF reconstructive surgery is advanced
• With a view to regenerative techniques, the learner will gain an understanding of current regenerative strategies for the CMF complex and their advantages and limitations in the various parts of the face

Sean P. Edwards, DDS, MD, FRCD(C), FACS

Clinical Associate Professor of Dentistry, Associate Professor of Surgery, Oral and Maxillofacial Surgery/Hospital Dentistry, University of Michigan Ann Arbor, Michigan, USA

Dr. Edwards received his dental degree from Dalhousie University in Halifax, Nova Scotia. He then came to the University of Michigan where he completed his medical degree and residency training in oral and maxillofacial surgery. He then completed fellowship training in pediatric cleft and craniofacial surgery at the University of Pittsburgh. A second fellowship in head and neck oncologic surgery and microvascular surgery brought him back to the University of Michigan where he has since remained as faculty.

Professionally, Dr. Edwards is the Chief of Pediatric Oral and Maxillofacial Surgery at C.S. Mott Children’s Hospital and the Associate Chair for Research in the Section of Oral and Maxillofacial Surgery. His research has focused on cleft and craniofacial care and sleep disorders, their genesis, and treatment. Dr. Edwards serves on many regional, national, and international committees, has served as a section editor for the International Journal of Oral and Maxillofacial Surgery, and reviews for many journals.

Abstract

Bone regeneration has greatly evolved over the last decades. Up until three decades ago, the leading method for the reconstruction of bone defects was native bone transferring, vascularized or non-vascularized, for reconstruction of the defect. This method has significant biological advantages; however, it also carries a high price tag, in the form of longer surgery, an additional surgical site, prolonged pain and discomfort, and greater rates of complications and morbidity. In recent decades, various materials have been developed, including allografts, xenografts, and alloplasts, in an attempt to promote bone regeneration without native bone transfer. However, these materials do not allow for the construction of high quality bone, nor are they appropriate for large defects or for many additional indications. The lecture will review 20 years of experience of both basic science and clinical work in the development and implementation of biological methods for high quality bone regeneration in various types of bone defects without the need for native bone transfer. The concept of bone growing will be presented, and the biological bone regeneration algorithm will be offered.

Learning Objectives

• Leading-edge biological bone regeneration technologies for high quality bone formation
• Introducing the concept of “Bone Growing”: Challenging clinical cases, intriguing translational research, and state of the arttechniques in the field of biological bone regeneration
• “Bone Growing” in different types of bony defects: A comprehensive step by step algorithm.

Nardy Casap, DMD, MD

Professor and Chairman, Department of Oral and Maxillofacial Surgery, Hebrew University-Hadassah Faculty of Dental Medicine, Jerusalem, Israel

After completion of his residency program in Oral and Maxillofacial Surgery at the Hadassah Medical Center, Prof. Casap spent two years in the department of Oral and Maxillofacial Surgery at the University of California, San Francisco.

Prof. Casap is a past chairman of the Israeli Association of Oral and Maxillofacial Surgery and the Israel chancellor of the International Association of Oral and Maxillofacial Surgery. He is an active member of the Israel Dental Association Scientific Committee, Chairman of the Israeli Maxillofacial Professional Committee, and Chairman of the National Accreditation Committee for Dental Specialization Programs. 

Prof. Casap is a member of the editorial boards of the Journal of Oral and Maxillofacial Surgery, Quintessence International, and numerous others. He has authored over 70 peer reviewed publications and book chapters. His main research interests are orthognathic and craniofacial surgery, navigation surgery systems, bone reconstruction, bone morphogenetic proteins, endoscopic surgery, and periosteal distraction.

Abstract

The primary objective in the reconstruction of maxillofacial continuity defects is the restoration of these defects to an appropriate esthetic form and functional capability. The material of choice for osseous grafting has been autologous corticocancellous bone, obtained using a variety of techniques, including traditional iliac crest graft harvest and vascularized free flap transfer. However, a major disadvantage of these approaches has been the potential complications and morbidity resulting from the need for a second surgical site and the extended length of surgery and hospital stay. The advent of tissue engineering was a major achievement in the surgical armamentarium.  Perhaps the greatest advantages of tissue-engineered grafts are the improved surgical efficiency and decreased risks associated with graft procurement. This depends on the recruitment and placement of osteocompetent cells into a favorable microenvironment. In general, an environment conducive for osteomigration and osteodifferentiation requires a biologic tissue scaffold and an adequate amount of growth signals without allowing ingrowth of fibrous tissue. Aspiration of bone marrow material, combined with an immediate centrifugation method, provides an effective, low-cost method for harvesting mesenchymal stem cells (MSCs) relatively safely. Allogeneic bone in particulate form can be used as a biologic scaffold, and recombinant human bone morphogenic protein-2 (rhBMP-2) is used to provide the required signaling agents and supporting growth factors. The composite tissue-engineered graft, although used sparingly in the past, is now a mainstay in the reconstruction of maxillomandibular continuity defects resulting from benign pathologic ablation or trauma at our institution (Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at Houston).

Learning Objectives

• Understanding which patients would benefit from tissue-engineered grafts
• Understanding the limitations of current tissue-engineered grafts.
• Discuss the science behind bone grafts and tissue-engineering
• Learn the principles of what makes tissue-engineering grafts regenerate bone.
• Review surgical technique and management of complications
• Learn surgical techniques to optimize bone regeneration and patient outcomes.

James Melville, DDS, FACS

Associate Professor, Department of Oral & Maxillofacial Surgery, Oral, Head & Neck Oncology and Microvascular Reconstructive Surgery, University of Texas Health Science Center at Houston

Dr. Melville earned a bachelor’s degree in biological sciences and history from the University of California Santa Barbara and graduated from the University of Michigan School of Dentistry in 2005. He completed a General Practice Residency at the University of California San Francisco in 2006 and served as assistant professor there until 2007. Dr. Melville then pursued and completed a residency in oral and maxillofacial surgery at the University of Miami/Jackson Memorial Hospital. After his surgical residency, Dr. Melville remained at the University of Miami to complete a two-year fellowship in maxillofacial head and neck oncology and microvascular reconstructive surgery.

Dr. Melville practices and teaches residents at Memorial Hermann Hospital, Ben Taub General Hospital, Houston Methodist Hospital, and Lyndon B. Johnson Hospital. His primary interests include maxillofacial trauma, head and neck oncology, head and neck microvascular surgery, facial reconstruction, bone-grafting, tissue-engineering, medication-related osteonecrosis of the jaw, and osteoradionecrosis of the jaw

He is the author of more than 10 articles in peer-reviewed journals and has authored three chapters in major oral and maxillofacial surgery textbooks.