Spontaneous Regeneration of the Mandible: An Institutional Audit of Regenerated Bone and Osteocompetent Periosteum

Abstract

Childhood mandibular lesions are frequently benign; this allows for a conservative surgical approach to their management. Two of the most common approaches for reconstruction of acquired mandibular defects in adolescents are vascularized and nonvascularized osseous flaps or grafts. A third, less commonly used treatment option often used in developing parts of the world that some Western centers are considering as part of their treatment algorithm is spontaneous bone regeneration. This study reports on the authors' experiences with spontaneous bone formation of the resected young mandible. It also attempts to quantify any relation between spontaneous bone regeneration and an aging osteocompetent periosteum. This was a retrospective study based on consecutive data collated from records of the oral and maxillofacial surgery departments from 2 tertiary institutions. Eligible patients were no older than 18years and had benign mandibular neoplasms. The surgical procedure was mandibulectomy with subperiosteal dissection and intermaxillary fixation. Regenerated bone evaluation was by clinical examination and periodic panoramic radiographs. Sixteen consecutive cases with mandibular lesions were seen at the 2 institutions, 8 of which met the inclusion criteria. The average age was 10.75years. The predominant pathology was unicystic ameloblastoma. All cases exhibited spontaneous bone regeneration, with 2 cases exhibiting "incomplete" bone regeneration. Immediate reconstruction can be delayed to allow for spontaneous bone regeneration of defects in young patients. In the absence of regeneration, secondary reconstruction can be considered. Although the literature reports more young patients with bone regeneration than adults, increasing age during childhood and adolescence might not necessarily indicate a decrease in periosteal bone-regenerating potential.