Mandibular biomechanics after marginal resection: Correspondences of simulated volumetric strain and skeletal resorption |
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| Institution: | 1. Hamburg University of Applied Sciences, Leuschnerstr. 25, D-21031 Hamburg, Germany;2. Department of Oral & Maxillofacial Surgery, Institute of Odontology, The Sahlgrenska Academy, PO Box 450, SE-40530 Gothenburg, Sweden;3. Institute for Mechanics of Materials and Structures, Vienna University of Technology, Karlsplatz 13/202, A-1040 Vienna, Austria;4. Mund-, Kiefer- und Plastische Gesichtschirurgie, Klinikum und Fachbereich Medizin, Johann Wolfgang Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, D-60596 Frankfurt am Main, Germany;5. Klinik für Mund-, Kiefer- und Gesichtschirurgie, University Hospital Basel, Spitalstr. 21, CH-4031 Basel, Switzerland;6. Hightech Research Center of Cranio-Maxillofacial Surgery (HFZ), University Hospital Basel, Gewerbestrasse 14, CH-4123 Allschwil, Switzerland;1. Professor and Head, Department of Prosthodontics and Occlusion, School of Dentistry, University of Oviedo, Oviedo, Spain;2. Clinical Assistant Professor, Department of Prosthodontics and Occlusion, School of Dentistry, University of Oviedo, Oviedo, Spain;3. Clinical Assistant Professor, Department of Prosthodontics and Occlusion, School of Dentistry, University of Oviedo, Oviedo, Spain;4. Associate Professor, Department of Prosthodontics and Occlusion, School of Dentistry, University of Oviedo, Oviedo, Spain;1. Postdoctoral Fellow, Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara City, Nara, Japan;2. Associate Professor, Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara City, Nara, Japan;3. Postdoctoral Fellow, Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara City, Nara, Japan;4. Postdoctoral Fellow, Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara City, Nara, Japan;6. Professor, Nihon University School of Dentistry, Tokyo, Japan;5. Professor and Chair, Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara City, Nara, Japan;1. Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, USA;2. Department of Biomedical Engineering, California Baptist University, Riverside, CA, USA;1. PhD Graduate Student, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan;2. Assistant Professor, Section of Maxillofacial Surgery, Department of Maxillofacial and Neck Reconstruction, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan;3. Doctor of Dentistry and Oral Surgery, NTT Medical Center Tokyo, Tokyo, Japan;4. Doctor and Chair of Dentistry and Oral Surgery, NTT Medical Center Tokyo, Tokyo, Japan; and, Clinical Professor, Section of Maxillofacial Surgery, Department of Maxillofacial and Neck Reconstruction, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan;5. Assistant Professor, Section of Oral Radiation Oncology, Department of Oral Health Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan;6. Professor and Chair, Section of Maxillofacial Surgery, Department of Maxillofacial and Neck Reconstruction, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan |
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| Abstract: | Serious mandibular diseases such as tumor or osteonecrosis often require segmental or marginal mandibulectomy, the latter with improved outcome thanks to preserved mandibular continuity. Nevertheless, gradual osteolytic and/or osteosclerotic skeletal changes frequently indicate repetitive resections. Based on the fundamental adaptivity of bone to mechanical loads, the question arose whether resection-related anatomical alterations trigger relevant pathological skeletal adaptations. For a clinical case after mandibular box resection due to progressive osteoradionecrosis (ORN), routine biomechanical loading was simulated by finite element method, respecting pathology-related anatomy, tissue properties, and biting capacity. By 3D-visualization of the mandible’s pathological development from follow-up-CT’s over four years, remarkable correspondences of skeletal resorptions and increased unphysiological strain were revealed. Higher unphysiological load was correlated with more serious and earlier skeletal alterations. Three months post-operatively, serious buccal destruction at the distal resection corner occurred in correspondence with dominant tensile strain. At the resection, elevated strain caused by reduced alveolar height corresponded to skeletal compromise, observed 8–9 months post-operatively. ORN-related lesions, diagnosed before resection, entailed unphysiological strain coinciding with local skeletal alterations. Simulations with “healthy” instead of pathological tissue coefficients induced quantitative improvements of 25–33%, but without fundamental change. These results suggest a decisive contribution of resection-related biomechanical skeletal adaptations to this patient’s mandibular decline with hemimandibulectomy about 2.5 years after the first resection. However, mechanical stress concentrations in sharp angles as the distal resection corner and reduced stability due to decreased alveolar height generally bear the danger of pathological biomechanics and severe skeletal adaptations for patients after mandibular box resection. |
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| Keywords: | Mandible Marginal mandibulectomy Finite element simulation Skeletal adaptation 3D-visualization |
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