1. Semmelweis University
Innovation of the maxillofacial reconstruction (during the last 30 years)
G. Szabo
Budapest
Semmelweis University

2. Many technique have been employed through the years to reconstruct the mandible

3. Reconstruction of mandibular defect
a, Maintenance the bone integrity
b, Alloplastic material
c, Conventional bone graft
d, Living bone graft
e, 3D printing reconstruction

6. Implants for mandibular reconstruction

7. The past

9. Vitalium implants

10. Various reconstraction plates

12. Osteosarcoma

19. Five years later

20. Melanoma metastasis in the central mandible

22. Two weeks postop.

26. Computer Generated Titanium Cranioplasty

28. Polytrauma 1991 From 1991-1998 (Only neurosugical treatment)
10 various operations on the cranio-maxillofacial region

34. Mandibular reconstruction with Carbon/Carbon implants Long-term results

35. Orthopedic and Cardiac surgery
Carbon implants
Carbon fibres
and
Polymer matrix
( 50% Carbon)
Orthopedic and Cardiac surgery
since 20 years
Carbon fibres
and
Pyrocarbon matrix
(99.99% Carbon)
Carbon / Carbon
New! ~

36. Carbomedics (Centerpulse)
Carbon fibres are mixed with other synthetic materials

37. Various devices of CarBulat™ implants

38. Comparative Parameters of CarBulat™
and Bone Tissue
Parameters
Bone
CarBulat™
Bending strength, Mpa
20-40
50-120
Modulus of Elasticity, Mpa
0,25x105
0,14-0,28x105
Deformation till breakage, % 2
1,1-1,5

39. Synovial sarcoma
23 year old girl

40. Carbon reconstruction

41. During the postop. irradiation

42. Titanium plate
Carbon
CT picture 10 months after surgery

43. 3 years after the CarBulat™ Reconstruction

44. Ewing sarcoma in the mandible after cytostatic treatment

46. 1 month postop.

47. 27 months after surgery

48. 8 years after the first implantation

49. Carbulat plate removing and reconstruction of the mandible with autogenous bone (iliac crest)

50. The Carbulat plate covered periost-like tissue

51. The Carbulat plate was fixed by osteosinthesis screws
After removing the plate black carbon particles remained on the spot

52. Carbulat plate before using
Removed Carbulat plate after 8 years of usage

53. SEM investigations Carbulat plate before using
Carbulat plate removed 8 years later

54. Iliac crest reconstruction with titanium plates

55. After reconstruction

56. Mandibular reconstruction with Carbulat plate
8 years result

57. Good cosmetic and functional result

58. 6 years after surgery

59. Hemifacial microsomia, double ribs transplant 13 years ago

60. Augmentation, preparation of the plate

61. Rib transplant

62. Before
One week postop.

63. 8 years postop

64. Indications for CarBulat™ reconstruction
Where living bone is not possible
Sufficient soft tissue for intraoral mucosa closure

65. 3D printing

66. New diagnostic technology in the maxillofacial vascular lesions

68. Maxillary artery

69. Question: AV-Hemangioma or Hypervascularised tumor?

70. Therapy plan: embolisation, tumor resection and reconstruction

71. Possibilities for the reconstruction I.

72. Possibilities for the reconstruction II.

76. 3D printed titanium plate