- 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.
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- 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.
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- University of Kiel researchers "grew" a replacement
jaw-bone in a muscle in the patient's back and grafted it in place.
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- The procedure, previously only tried on animals, was
detailed in The Lancet.
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- The operation took place nine weeks ago, and the patient
can now eat steak - if it is cut up for him.
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- The patient says he now wants teeth fitted, so he can
eat his steak before it gets cold. Doctors say he could get them next year.
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- 3D scans
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- In cases such as his, surgeons usually take a piece of
bone from elsewhere in the body, often the thigh, to repair the jaw.
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- But this damages the bone in that part of the body, which
can itself lead to serious illness.
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- In this case, the patient's jaw had been bridged with
a 7cm titanium reconstruction plate since his initial operation.
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- 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.
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- So it was decided to attempt the new technique.
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- 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).
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- The design was used to construct a teflon model, which
was then covered with a titanium cage.
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- The teflon was then removed, and the cage filled with
bone mineral blocks, coated with bone marrow and a protein which accelerates
bone growth.
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- The transplant was then implanted into the latissimus
dorsai muscle, below the right shoulder blade.
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- Doctors monitored its development, and CT scans showed
new bone was forming.
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- After seven weeks of growth, the graft was removed, along
with a flap of muscle containing blood vessels.
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- It was then attached to the stumps of the patient's original
lower jaw.
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- The transplant enabled the patient to chew again, and
within four weeks he was able to eat solid foods.
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- 'Quality of life'
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- 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.
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- 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.
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- "For us to draw firm conclusions, an extended period
of follow-up is necessary."
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- 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."
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- He said implanting the cage into the patient's muscle
meant his own tissue developed around it.
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- "Because it was his own tissue, we don't expect
any problems of rejection."
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- 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."
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- 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.
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- 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."
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- © BBC MMIV http://news.bbc.co.uk/2/hi/health/3598710.stm
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