Management of Mandibular Osteomyelitis With Segmental Resection, Nerve Preservation, and Immediate Reconstruction

Abstract

The purpose was to present our experience with management of mandibular osteomyelitis with segmental resection, nerve preservation, and immediate reconstruction with nonvascularized bone grafts. We completed a retrospective analysis of 18 cases overseen by a single practitioner at a university medical center from June 2011 to July 2018. All patients had osteomyelitis and were treated with segmental mandibular resection, inferior alveolar nerve (IAN) preservation, and immediate reconstruction with autogenous bone graft from the tibia. Data obtained from medical records included the chief complaint at initial presentation, resection size, and IAN neurosensory recovery at 6months, as well as descriptive statistics of the patient cohort. The university institutional review board granted this study exempt status. The patient cohort had a mean age of 50.9years, ranging from 29 to 70years, and included 11 female and 7 male patients. The mean follow-up time was 15months. The most common chief complaint at initial presentation was pathologic fracture (39%), followed closely by abscess (33%). The average mandibular resection size of all patients was 8.1cm (standard deviation [SD], 3.3cm). The resection size measured 7.1cm (SD, 2.6cm) in patients with successful bone grafts (n=15) and 13.1cm (SD, 2.0cm, P=.0016) in those with graft failure (n=3). IAN neurosensory testing showed that 54% of patients had no meaningful recovery at 6months, 25% had partial recovery, and 21% had full recovery. Finally, osteomyelitis was eliminated in all patients. Segmental mandibular resection is an effective method for eradicating mandibular osteomyelitis. Furthermore, immediate reconstruction via nonvascularized grafts is successful in cases with large defects, with a mean defect size of 7.1±2.6cm. However, IAN-sparing surgery is not effective for preserving patient IAN function. Taken together, our findings show that mandibular resection with immediate reconstruction is a viable method in the treatment of mandibular osteomyelitis. This method removes infection and shortens the disease course.