Regenerative Engineering in Maxillofacial Reconstruction

Oral cancer is the sixth most common cancer worldwide, with approximately 275,000 new cases each year. In some countries, mortality rates reach as high as 70 %. For patients that survive, bodily functions of speaking, swallowing, and chewing are severely compromised. Although there has been improvement in free tissue transfer techniques and virtual planning with implant placement, maxillofacial reconstruction techniques need refinement to allow greater improvement in functional outcomes and quality of life. Regenerative engineering principles provide a potential means of improving maxillofacial tissue regeneration. Maxillofacial reconstruction requires unique insights to maximize clinical impact. Because traditional cancer treatment can include radiation therapy, defect sites may experience hypoxia and experience thrombosis and fibrosis, which complicate restoration [1]. Several cell sources, such as periosteal-derived progenitor cells (PDPCs) and bone marrow-derived mesenchymal stem cells (BMSCs) have been evaluated for use in maxillofacial reconstruction, with variable success. From our comprehensive review of the literature, there is a significant need to further the application of regenerative engineering principles to maxillofacial regeneration following oral cancer treatment. Lay Summary The prevalence of oral cancer and limitations of treatments invites regenerative engineering approaches. While combatting cancer, tissue removal, radiation, and/or chemotherapy often significantly reduce the patient's quality of life. A high-quality functional outcome following treatment means the ability to readily perform the seemingly simplest of biological tasks that humans often take for granted-swallowing, breathing, coughing, and speaking intelligibly. Indeed, damage due to clinical treatments may include normal tissues at the cancer site but can also extend to surrounding tissues such as teeth. A regenerative engineering approach, involving tissue enhancement with cellular materials, would allow tissue to be rebuilt following and during potentially harmful clinical treatments.