Semmelweis University Innovation of the maxillofacial reconstruction (during the last 30 years) G. Szabo Budapest Semmelweis University

Many technique have been employed through the years to reconstruct the mandible

Reconstruction of mandibular defect a, Maintenance the bone integrity b, Alloplastic material c, Conventional bone graft d, Living bone graft e, 3D printing reconstruction

Implants for mandibular reconstruction

The past

Vitalium implants

Various reconstraction plates

Osteosarcoma

Five years later

Melanoma metastasis in the central mandible

Two weeks postop.

Computer Generated Titanium Cranioplasty

Polytrauma 1991 From 1991-1998 (Only neurosugical treatment) 10 various operations on the cranio-maxillofacial region

Mandibular reconstruction with Carbon/Carbon implants Long-term results

Orthopedic and Cardiac surgery Carbon implants Carbon fibres and Polymer matrix ( 50% Carbon) Orthopedic and Cardiac surgery since 20 years Carbon fibres and Pyrocarbon matrix (99.99% Carbon) Carbon / Carbon New! ~

Carbomedics (Centerpulse) Carbon fibres are mixed with other synthetic materials

Various devices of CarBulat™ implants

Comparative Parameters of CarBulat™ and Bone Tissue Parameters Bone CarBulat™ Bending strength, Mpa 20-40 50-120 Modulus of Elasticity, Mpa 0,25x105 0,14-0,28x105 Deformation till breakage, % 2 1,1-1,5

Synovial sarcoma 23 year old girl

Carbon reconstruction

During the postop. irradiation

Titanium plate Carbon CT picture 10 months after surgery

3 years after the CarBulat™ Reconstruction

Ewing sarcoma in the mandible after cytostatic treatment

1 month postop.

27 months after surgery

8 years after the first implantation

Carbulat plate removing and reconstruction of the mandible with autogenous bone (iliac crest)

The Carbulat plate covered periost-like tissue

The Carbulat plate was fixed by osteosinthesis screws After removing the plate black carbon particles remained on the spot

Carbulat plate before using Removed Carbulat plate after 8 years of usage

SEM investigations Carbulat plate before using Carbulat plate removed 8 years later

Iliac crest reconstruction with titanium plates

After reconstruction

Mandibular reconstruction with Carbulat plate 8 years result

Good cosmetic and functional result

6 years after surgery

Hemifacial microsomia, double ribs transplant 13 years ago

Augmentation, preparation of the plate

Rib transplant

Before One week postop.

8 years postop

Indications for CarBulat™ reconstruction Where living bone is not possible Sufficient soft tissue for intraoral mucosa closure

3D printing

New diagnostic technology in the maxillofacial vascular lesions

Maxillary artery

Question: AV-Hemangioma or Hypervascularised tumor?

Therapy plan: embolisation, tumor resection and reconstruction

Possibilities for the reconstruction I.

Possibilities for the reconstruction II.

3D printed titanium plate