Biomechanical analysis of bone remodeling following mandibular reconstruction using fibula free flap
Affiliations
Affiliations
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 9808575, Japan; School of Aerospace, Mechanical and Mechatronic Engineering, The University of Sydney, NSW 2006, Australia. Electronic address: nobuhiro.yoda.e2@tohoku.ac.jp.
- School of Aerospace, Mechanical and Mechatronic Engineering, The University of Sydney, NSW 2006, Australia.
- Department of Biomaterials, Max Planck Institute of Colloids and Interfaces, Am Mühlenberg 1 OT Golm, 14476 Potsdam, Germany.
- Maxillofacial Prosthetics Clinic, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 9808575, Japan.
- Faculty of Dentistry, The University of Sydney, Sydney, NSW, 2006, Australia.
- Department of Bioclinical Sciences, Faculty of Dentistry, Kuwait University, Safat 13110, Kuwait.
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 9808575, Japan.
Abstract
Whilst the newly established biomechanical conditions following mandibular reconstruction using fibula free flap can be a critical determinant for achieving favorable bone union, little has been known about their association in a time-dependent fashion. This study evaluated the bone healing/remodeling activity in reconstructed mandible and its influence on jaw biomechanics using CT data, and further quantified their correlation with mechanobiological responses through an in-silico approach. A 66-year-old male patient received mandibular reconstruction was studied. Post-operative CT scans were taken at 0, 4, 16 and 28 months. Longitudinal change of bone morphologies and mineral densities were measured at three bone union interfaces (two between the fibula and mandibular bones and one between the osteotomized fibulas) to investigate bone healing/remodeling events. Three-dimensional finite element models were created to quantify mechanobiological responses in the bone at these different time points. Bone mineral density increased rapidly along the bone interfaces over the first four months. Cortical bridging formed at the osteotomized interface earlier than the other two interfaces with larger shape discrepancy between fibula and mandibular bones. Bone morphology significantly affected mechanobiological responses in the osteotomized region (R2 > 0.77). The anatomic position and shape discrepancy at bone union affected the bone healing/remodeling process.
Keywords: Bone remodeling; Fibula free flap; Finite element analysis; Jaw biomechanics; Mandibular reconstruction.
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