Curvilinear Segmental Mandibular Reconstruction Utilizing Distraction Osteogenesis and Early Open Callus Manipulation.

Abstract

The authors present a new technique for reconstruction of large curvilinear mandibular defects with distraction osteogenesis and early open callus manipulation. In phase 1, transport disks are created from mandibular bone and distracted across the entire length of the defect, without the restriction from a mandible plate fixation. This allows for full-length distraction until enough regenerate is obtained to reconstruct the defect without the need for additional bone grafts. Taking advantage of the soft moldable regenerate, the second and final operative procedure allows for the manipulation, repositioning, and fixation of the transported segments in the ideal position creating perfect tridimensional form and symmetry of the mandible arch. In addition, the consolidation phase is shortened by the early removal of distractors, substantially reducing the total length of treatment. This article describes 2 clinical cases treated according to this technique, one with a 6-cm mandibular defect where a sagittal plane manipulation was performed, and the other with a 7-cm defect and axial plane manipulation. Five years postsurgery, both patients had achieved full stable reconstruction without the need for bone grafting, and had obtained good facial symmetry, with no recorded complications. This technique serves to establish bone transport as a valuable alternative to bone free flaps in the reconstruction of large curvilinear segmental mandibular defects.