Uncovering the unique characteristics of the mandible to improve clinical approaches to mandibular regeneration

Ana Prates Soares; Heilwig Fischer; Sabrin Aydin; Claudius Steffen; Katharina Schmidt-Bleek; Carsten Rendenbach

doi:10.3389/fphys.2023.1152301

Uncovering the unique characteristics of the mandible to improve clinical approaches to mandibular regeneration

Front Physiol. 2023 Mar 17:14:1152301. doi: 10.3389/fphys.2023.1152301. eCollection 2023.

Authors

Ana Prates Soares^{1

2}, Heilwig Fischer^{1

3

4}, Sabrin Aydin¹, Claudius Steffen¹, Katharina Schmidt-Bleek^{2

5}, Carsten Rendenbach¹

Affiliations

¹ Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
² Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany.
³ Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
⁴ BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany.
⁵ Berlin Institute of Health Centre for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany.

Abstract

The mandible (lower jaw) bone is aesthetically responsible for shaping the lower face, physiologically in charge of the masticatory movements, and phonetically accountable for the articulation of different phonemes. Thus, pathologies that result in great damage to the mandible severely impact the lives of patients. Mandibular reconstruction techniques are mainly based on the use of flaps, most notably free vascularized fibula flaps. However, the mandible is a craniofacial bone with unique characteristics. Its morphogenesis, morphology, physiology, biomechanics, genetic profile, and osteoimmune environment are different from any other non-craniofacial bone. This fact is especially important to consider during mandibular reconstruction, as all these differences result in unique clinical traits of the mandible that can impact the results of jaw reconstructions. Furthermore, overall changes in the mandible and the flap post-reconstruction may be dissimilar, and the replacement process of the bone graft tissue during healing can take years, which in some cases can result in postsurgical complications. Therefore, the present review highlights the uniqueness of the jaw and how this factor can influence the outcome of its reconstruction while using an exemplary clinical case of pseudoarthrosis in a free vascularized fibula flap.

Keywords: bone regeneration; free tissue flap; mandible; mandibular reconstruction; morphogenesis; morphophysiology.

Publication types

Review

Grants and funding

The authors acknowledge the support of the European Union (EU) Horizon 2020 project InterLynk (grant agreement: H2020-NMBP-TR-IND-2020, project ID: 953169) for the present work. HF is a participant in the BIH-Charité Clinician Scientist Programme funded by the Charité—Universitäts-Medizin Berlin and the Berlin Institute of Health. We acknowledge financial support from the Open Access Publication Fund of Charité—Universitätsmedizin Berlin and the German Research Foundation (DFG).