Deep circumflex iliac artery flap combined with a costochondral graft for mandibular reconstruction

Abstract

Our aim was to use the deep circumflex iliac artery (DCIA) flap together with a costochondral graft as a safe and reliable bone flap for routine reconstruction of the mandibular body and the temporomandibular joint (TMJ). Five patients with benign tumours of the mandible had segmental mandibulectomy including the condyle, and this was reconstructed in one stage using the DCIA combined with a constochondral graft. The rib was inserted into the iliac crest as a whole transplant, and fixed to the proximal stump of the mandible with a prebent reconstruction plate according to a computer-aided design. The grafts healed uneventfully, and dental implants were inserted in 4 cases. During the 2-year follow-up these patients had good mandibular function, including mouth opening, force of bite, and occlusion. The radiographs showed good bony consolidation between the graft and the stump of the mandible and function of the TMJ. A DCIA flap combined with a costochondral graft is a safe and reliable way to provide not only a large bulk of bone to suit the mandible, but also good function of the TMJ in the absence of radiotherapy.