Biomechanical analysis of bone remodeling following mandibular reconstruction using fibula free flap. (June 2018)

• Record Type: Journal Article
• Authors: Yoda, Nobuhiro; Zheng, Keke; Chen, Junning; Liao, Zhipeng; Koyama, Shigeto; Peck, Christopher; Swain, Michael; Sasaki, Keiichi; Li, Qing
• Is Part Of: Medical engineering & physics. Volume 56(2018)
• Page Start: 1
• Page End: 8
• Publication Date: 2018-06
• Subjects: Fibula free flap -- Finite element analysis -- Jaw biomechanics -- Mandibular reconstruction -- Bone remodeling; Biomedical engineering -- Periodicals; Biomedical Engineering -- Periodicals; Physics -- Periodicals; Génie biomédical -- Périodiques; Biomedical engineering; Electronic journals; Periodicals; 610.28
• DOI: 10.1016/j.medengphy.2018.03.008
• Languages: English
• ISSNs: 1350-4533

Abstract

Highlights: The longitudinal changes in bone morphology and mineral density systematically in the course of healing/remodeling after mandibular reconstruction with fibula free flap were quantified. The mutual influence between the changes in tissue conditions and mandibular mechanobiology by establishing a combined in-vivo and in-silico approach was assessed for the first time. Novel understanding of mechanobiological responses in a healing and remodeling of mandible following mandibular reconstruction was provided. 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 ( R 2 > 0.77). The anatomic position and shape discrepancy at bone union affected the bone healing/remodeling process.