Nonvascularized Bone Grafts for Reconstruction of Segmental Mandibular Defects: Is Length of Graft a Factor of Success?

Abstract

The purpose of this study was to evaluate a long-debated question in the field of whether the success of reconstructing mandibular defects with nonvascularized bone grafts (NVBGs) is dependent on the length of the graft. The inclusion criteria were patients who had received NVBGs, such as anterior or posterior iliac crest and costochondral grafts, to reconstruct segmental defects of the mandible between 2008 and 2017 at the Department of Oral and Maxillofacial Surgery at Case Western Reserve University. Patients with a history of irradiation of the head and neck and patients with inadequate follow-up were excluded from this study. Data such as defect length, patient age, comorbidities, length of follow-up, location of defect, etiology of defect, and postoperative course were collected. Success was judged by radiographic and clinical evidence of bone continuity and stability at a minimum of 4months postoperatively. Failures were considered loss of all or part of the graft, resulting in a residual continuity defect requiring further bone grafting. We identified 61 potential cases, of which 29 met the inclusion and exclusion criteria. The mean age of the patients at the time of grafting was 55years (range, 17 to 81years), with a mean follow-up length of 18months. The length of defects ranged from 2 to 22cm. The grafts were 6cm or less in length in 7 defects and greater than 6cm in length in 22 defects. All cases were grafted at a minimum of 6months after resection, and bone morphogenetic protein was used in 25 cases (86%).Failure occurred in 1 patient in the group with grafts of 6cm or less and 2 patients in the group with grafts greater than 6cm, corresponding to success rates of 86% and 91%, respectively. Eight patients experienced minor complications such as wound dehiscence or infection, which resolved with local measures and antibiotics. The results of our study show that NVBGs are a viable, safe, and effective treatment option for segmental mandibular defects over 6cm in length in non-irradiated patients.