Docs grow new jawbone for cancer survivor

In a new study, researchers describe a man whose jaw was successfully reconstructed using a bone that was grown from scratch under the muscles in his back.

The benefit of this approach is that doctors don't need to remove bone from elsewhere in the body in order to create the new jawbone.

The case, which is reported in The Lancet, involved a 56-year-old man who lost a substantial portion of his jawbone, also called the mandible, during cancer surgery. After 9 years of eating only soft food and soup, the patient asked the researchers to reconstruct his mandible.

Dr. Patrick H. Warnke, from the University of Kiel in Germany, and colleagues began the reconstruction by taking three-dimensional CT images of the man's mandible. Using computer-aided design techniques, the team created an image of what the replacement bone graft should look like.

This "virtual" replacement was then used to construct a matching metal cage. The researchers filled this cage with bone mineral blocks, a bone-inducing chemical called BMP7, and some of the patient's bone marrow. Next, the cage was implanted in a back muscle called the latissimus dorsi to allow real bone to form inside the metal mold.

After 7 weeks in the patient's back, the cage was removed and the bone that had formed was used to rebuild the mandible, the investigators report.

The patient's chewing ability improved after surgery and by 4 weeks the patient was able to enjoy his first dinner in nearly a decade. According to the authors, the patient was satisfied with the cosmetic outcome of the procedure as well.

"We suggest that our results represent a proof of principle," the authors note. "We hope to present this patient's long-term outcome and those of future patients at a later date."

"There is little doubt that scientists and clinicians alike will continue to challenge the benefits and merits of novel regenerative medical procedures," Dr. Stan Gronthos, from the Institute of Medical and Veterinary Science in Adelaide, Australia, notes in a related editorial. "Meanwhile, as the debates continue, a patient who had previously lost his mandible...can now sit down to chew his first solid meals in 9 years, courtesy of a new mandible-like" bone graft.

SOURCE: The Lancet, August 28, 2004.