Reconstruction of the Mandibular Ramus/Condyle Unit Following Resection of Benign and Aggressive Lesions of the Mandible

Abstract

The reconstruction of mandibular continuity defects using autogenous bone has a varied history. Segmental defects of a centimeter or less, if adequately immobilized, may well regenerate spontaneously without the need for a bone graft, particularly in younger patients. 1 Prein J. Treatment of Infected Fractures and Pseudarthrosis of the Mandible. in: Springer-Verlag, New York, NY1976: 169 Google Scholar , 2 Leopard P. Complications. Churchill Livingstone, New York, NY1985: 730 Google Scholar The immediate (or even delayed) nonvascularized intraoral grafting of larger segmental defects of the mandible has generally met with unacceptably high failure rates. 3 Millard D.R. Campbell R.C. Stokley P. et al. Interim report on immediate mandibular repair. Am J Surg. 1969; 118: 726 Abstract Full Text PDF PubMed Scopus (18) Google Scholar , 4 Ardary W.C. Reconstruction of mandibular discontinuity defects using autogenous grafting and a mandibular reconstruction plate: A prospective evaluation of nine consecutive cases. J Oral Maxillofac Surg. 1993; 51: 125 Abstract Full Text PDF PubMed Scopus (16) Google Scholar , 5 Schuller D.E. Bardach J. Monteith C.G. et al. Titanium tray mandibular reconstruction. Arch Otolaryngol. 1982; 108: 174 Crossref Scopus (17) Google Scholar , 6 Kudo K. Fujioka Y. Review of bone grafting for reconstruction of discontinuity defects of the mandible. J Oral Surg. 1978; 36: 791 PubMed Google Scholar , 7 Tidstrom K.D. Keller E.E. Reconstruction of mandibular discontinuity with autogenous iliac bone graft: Report of 34 consecutive patients. J Oral Maxillofac Surg. 1990; 48: 336 Abstract Full Text PDF PubMed Scopus (50) Google Scholar , 8 Lawson W. Biller H.F. Mandibular reconstruction: bone graft techniques. Otolaryngol Head Neck Surg. 1982; 90: 589 PubMed Google Scholar , 9 Lawson W. Loscalzo L.J. Baek S.M. et al. Experience with immediate and delayed mandibular reconstruction. Laryngoscope. 1982; 92: 5 Crossref PubMed Scopus (106) Google Scholar , 10 Adamo A.K. Szal R.L. Timing, results, and complications of mandibular reconstructive surgery: Report of 32 cases. J Oral Surg. 1979; 37: 755 PubMed Google Scholar This is probably because of a combination of salivary contamination of the graft, which decreases the number of viable cells, and the difficulty of obtaining a watertight intraoral closure, which leads to the possibility of wound breakdown. 11 Conley J.J. A technique of immediate bone grafting in the treatment of benign and malignant tumors of the mandible and a review of seventeen consecutive cases. Cancer. 1953; 6: 568 Crossref PubMed Scopus (26) Google Scholar There are, however, a small number of reports of successful large intraoral mandibular bone grafts carried out at the time of resection. 11 Conley J.J. A technique of immediate bone grafting in the treatment of benign and malignant tumors of the mandible and a review of seventeen consecutive cases. Cancer. 1953; 6: 568 Crossref PubMed Scopus (26) Google Scholar , 12 Manchester W.M. Immediate reconstruction of the mandible and temporomandibular joint. Br J Plast Surg. 1965; 18: 291 Abstract Full Text PDF PubMed Scopus (43) Google Scholar , 13 Obwegeser H.L. Simultaneous resection and reconstruction of parts of the mandible via the intraoral route in patients with and without gross infections. Oral Surg Oral Med Oral Pathol. 1966; 21: 693 Abstract Full Text PDF Scopus (46) Google Scholar , 14 Obwegeser H.L. Primary repair of the mandible by the intraoral route after partial resection in cases with and without pre-operative infection. Br J Plast Surg. 1968; 21: 282 Abstract Full Text PDF Scopus (10) Google Scholar