from http://news.bbc.co.uk/2/hi/health/3598710.stm

   
Last Updated: Friday, 27 August, 2004, 07:11 GMT 08:11 UK  

New jaw grown on patient's back

The new bone was grown in a muscle on the patient's back

A German man has been able to eat his first proper meal in nine years
after surgeons rebuilt his face using a pioneering jaw-bone graft.

The 56-year-old man - who tucked into bread and sausages - had only
been able to eat soft food and soup since part of his jaw-bone was
removed due to cancer.

University of Kiel researchers "grew" a replacement jaw-bone in a
muscle in the patient's back and grafted it in place.

The procedure, previously only tried on animals, was detailed in The
Lancet.

The operation took place nine weeks ago, and the patient can now eat
steak - but it has to be cut up for him because he has no teeth to
bite through the meat.

The patient says he now wants a set of teeth fitted, so he can eat his
steak before it gets cold. Doctors say he could get them next year.

3D scans

In cases such as his, surgeons usually take a piece of bone from
elsewhere in the body, often the thigh, to repair the jaw.

But this damages the bone in that part of the body, which can itself
lead to serious illness.

A patient who had previously lost his mandible through the result of
a destructive tumour can now sit down to chew his first solid meals in
nine years

In this case, the patient's jaw had been bridged with a 7cm titanium
reconstruction plate since his initial operation.

He was also taking the blood-thinning drug warfarin for an aortic
aneurysm, which meant the traditional bone graft method carried a risk
of post-operative bleeding.

So it was decided to attempt the new technique.

After taking a 3D computer tomography (CT) scan of the patient's head,
they used computer aided design to recreate the missing portion of the
jaw-bone (mandible).

The design was used to construct a teflon model, which was then
covered with a titanium cage.

The teflon was then removed, and the cage filled with bone mineral
blocks, coated with bone marrow and a protein which accelerates bone
growth.

The transplant was then implanted into the latissimus dorsai muscle,
below the right shoulder blade.

Doctors monitored its development, and CT scans showed new bone was
forming.

After seven weeks of growth, the graft was removed, along with a flap
of muscle containing blood vessels.

It was then attached to the stumps of the patient's original lower
jaw.

The transplant enabled the patient to chew again, and within four
weeks he was able to eat solid foods.

'Quality of life'

The researchers, led by Dr Patrick Warnke of the Department of Oral
and Maxillofacial Surgery at the University of Kiel, say there is a
need for greater understanding about the long-term effects of the
procedure.

Writing in The Lancet, they said: "The exciting nature of the result
achieved in this patient to date has prompted our group to extend this
trial.

"For us to draw firm conclusions, an extended period of follow-up is
necessary."

But Dr Warnke told BBC News Online he hoped the procedure could help
many other patients, adding: "In addition to helping patients such as
this man, we hope it could be used in orthopaedic surgery."

He said implanting the cage into the patient's muscle meant his own
tissue developed around it.

"Because it was his own tissue, we don't expect any problems of
rejection."

He added: "It was a very successful operation, because when we fitted
it to his existing jaw, it was a very good fit, We didn't have to make
a lot of changes."

Dr Stan Gronthos, of the division of haematology at the Institute of
Medical and Veterinary Science in Adelaide, Australia, said the German
research proved this technique could help patients with damaged
jaw-bones.

He wrote in The Lancet: "Meanwhile, as the debate continues, a patient
who had previously lost his mandible through the result of a
destructive tumour can now sit down to chew his first solid meals in
nine years, courtesy of a new mandible-like structured implant,
resulting in an improved quality of life for that individual."