Reconstruction Of Segmental Mandibular Defects Research Articles

Nonvascularized bone grafts: how successful are they in reconstruction of segmental mandibular defects?

ObjectiveSegmental mandibular defects can occur due to various etiologies, including trauma and tumor resection. Reconstruction should provide adequate support for subsequent dental rehabilitation and allow for proper occlusion. Non-vascularized bone grafts have been used for reconstructing mandibular defects in cases where vascularized grafts were not feasible. The objective of this study was to assess the success rate of these grafts in reconstruction of segmental defects of various sizes in the mandible. Study DesignFifty patients were included in this retrospective chart review. Length of the grafts varied from 3 to 20 cm and patients were followed-up from 4 to 80 months. Fifteen grafts were harvested from anterior iliac crest, 23 from posterior iliac crest, 9 grafts were a combination of either with costochondral graft, and 3 were solely allografts. Bone morphogenetic protein was utilized in 41 cases as an adjunct. ResultsSuccess was defined as continuity of bone clinically and radiographically at a 4-month follow-up. Non-vascularized bone grafting was successful in %90 of cases. Complications were observed in %34 of cases, of which the most common were infection followed by wound dehiscence. ConclusionOur study demonstrated substantial success rate with non-vascularized bone grafts in reconstruction of segmental mandibular defects.

Frequency of post-radiation plate extrusion in mini plate versus reconstruction plate for mandibular reconstruction in oncologic surgeries of mandible.

Objective: To compare plate extrusion rates of mini-plates versus reconstruction plates in the fixation of vascularized fibula into segmental mandibular defects. Study Design: Retrospective Review. Setting: Department of Plastic and Reconstructive surgery, Liaquat National Hospital, Karachi, Pakistan. Period: January 2017 to December 2019. Material & Methods: In this retrospective review, 38 patients were included who underwent free fibular reconstruction of segmental mandibular defects after oncologic resection of bone and adjuvant radiotherapy. Patient data and post radiation plate extrusion rates were recorded; the results were compared between patients who had segmental fibular reconstruction of their mandibular defect with mini- plates (n = 18) with those who underwent repair using reconstruction plates (n = 20). Average follow up were 18 ± 3 week. Results: Statistically significant difference was identified in decrease number of extrusion of plate after post radiation in mini-plates group (5.5%) versus reconstruction plate (15%). Over all complication of both groups are same. Conclusion: After oncologic resection of mandible and reconstruction with free fibula flap patient underwent radiotherapy which result in scarring and shrinkage of facial skin that lead to wound dehiscence and exposure of underlying plate. By using mini plate this exposure of plate incidence is lower.

Miniplate Versus Reconstruction Bar Fixation for Oncologic Mandibular Reconstruction with Free Fibula Flaps.

Fibula free flaps (FFF) are the gold standard tissue for the reconstruction of segmental mandibular defects. A comparison of miniplate (MP) and reconstruction bar (RB)-based fixation of FFFs has been previously described in a systematic review; however, long-term, single-center studies comparing the two plating methods are lacking. The authors aim to examine the complication profile between MPs and RBs at a single tertiary cancer center. We hypothesized that increased components and a lack of rigid fixation inherent to MPs would lead to higher rates of hardware exposure/failure. A retrospective review was performed from a prospectively maintained database at Memorial Sloan Kettering Cancer Center. All patients who underwent FFF-based reconstruction of mandibular defects between 2015 and 2021 were included. Data on patient demographics, medical risk factors, operative indications, and chemoradiation were collected. The primary outcomes of interest were perioperative flap-related complications, long-term union rates, osteoradionecrosis (ORN), return to the operating room (OR), and hardware exposure/failure. Recipient site complications were further stratified into two groups: early (<90 days) and late (>90 days). In total, 96 patients met the inclusion criteria (RB = 63, MP = 33). Patients in both groups were similar with respect to age, presence of comorbidities, smoking history, and operative characteristics. The mean follow-up period was 17.24 months. In total, 60.6 and 54.0% of patients in the MP and RB cohorts received adjuvant radiation, respectively. There were no differences in rates of hardware failure overall; however, in patients with an initial complication after 90 days, MPs had significantly higher rates of hardware exposure (3 vs. 0, p = 0.046). MPs were found to have a higher risk of exposed hardware in patients with a late initial recipient site complication. It is possible that improved fixation with highly adaptive RBs designed by computer-aided design/manufacturing technology explains these results. Future studies are needed to assess the effects of rigid mandibular fixation on patient-reported outcome measures in this unique population.

Validation of Low Cost Patient Specific Implant Design Using Finite Element Analysis (FEA) for Reconstruction of Segmental Mandibular Defects: A Case Report and Literature Review

Validation of Low Cost Patient Specific Implant Design Using Finite Element Analysis (FEA) for Reconstruction of Segmental Mandibular Defects: A Case Report and Literature Review

NANOTEX BONE Graft along with Fibula Flap in the Reconstruction of Segmental Mandibular Defect: Protocol for Pilot Clinical Trial.

Mandible reconstruction with vascularized fibula flap is the standard treatment for segmental mandibulectomy in patients with tumor or trauma. But the height of the fibula graft is insufficient for dental implant placement and prosthetic rehabilitation to replace the missing teeth, which in turn will compromise the functional efficiency and aesthetics of the patient. Although the bone height can be augmented through onlay grafting with iliac crest, it is associated with limitations like donor site morbidity and fast resorbability. This suggests the need for a synthetic biomaterial for vertical bone augmentation in implant dentistry.We have developed a biomimetic, porous, mechanically stable, and biodegradable nanocomposite named "NANOTEX BONE Graft" and its bone regeneration potential was evaluated in pre-clinical animal models. In this clinical trial, the safety as well as the efficacy of NANOTEX to augment new bone over fibula and further its ability to integrate with dental implants will be studied. The study has received the approval of the Ethics Committee of Amrita Institute of Medical Sciences and Central Drugs Standard Control Organization (CDSCO), India. We have designed a prospective, single-center, non-randomized pilot clinical study. Patients with benign tumor or trauma indicated for mandibular reconstruction followed by implant rehabilitation will be included in the study. Eligible patients will be enrolled after obtaining informed consent. The study will be initiated and followed up as per defined timelines. Resection of benign mandibular tumours necessitates surgical removal of jaw bone and adjacent affected areas.The segmental mandibulectomy leaves the patient with functional impairments and aesthetic defects which in turn affect the quality of life.The standard treatment of reconstruction with vascularized fibula flap has challenge in achieving sufficient vertical bone height for implant placement and prosthetic rehabilitation.Alternate surgical techniques cause donor site morbidity and surgical complications.There is need for a synthetic biomaterial to be grafted over fibula for vertical bone augmentation.NANOTEX BONE Graft, a nanofibrous composite scaffold that mimics native bone, promote cell infiltration, neo-angiogenesis and new bone formation.Preclinical studies of NANOTEX in animal models showed bone tissue regeneration, better biodegradation in critical sized defects and efficient integration with dental implants.This clinical study propose to evaluate the safety and efficacy of NANOTEX bone graft augmented over fibula in bone regeneration and Titanium dental implant integration.

Dual Application of Patient-Specific Occlusion-Based Positioning Guide and Fibular Cutting Guide for Accurate Reconstruction of Segmental Mandibular Defect.

In this study, the authors introduced a dual application of patient-specific occlusion-based positioning guide and fibular cutting guide to obtain ideal occlusal relationship and mandibular contour in patients undergoing mandibular reconstruction. A retrospective review was performed in 21 patients who underwent mandibular reconstruction with a fibular osteocutaneous free flap. Using computed tomography and intraoral scanning data, fibular cutting guide and occlusion-based positioning guide were simulated in a modeling software and 3-dimensionally printed. Both guides were applied in 9 patients, defined as dual guide group, while the fibular cutting guide was solely used in the remaining patients, defined as single guide group. Functional outcomes including occlusion status, trismus, presence of osseointegrated implant were assessed at 1-year postoperative period. To evaluate the accuracy of the reconstruction, the discrepancy between the planned simulation and actual surgical result was quantified by measuring mandibular deviation angle and volume conformity. Regarding the functional outcomes, all patients in dual guide group showed satisfactory occlusion and intact oral capacity at postoperative 1-year assessment, while 3 patients in single guide group had prolonged malocclusion. The dual guide group showed significantly decreased deviation angle in coronal (right side, 2.93°±1.98° vs. 7.02°±2.81°, P =0.003) and axial plane (right side, 3.20°±2.04° vs. 7.63°±3.40°, P =0.006). The mean volume conformity between the simulation and actual fibular object was significantly higher in the dual guide group (75.27%±6.12% vs. 59.06%±8.57%, P =0.001). In conclusion, the use of occlusion-based positioning guide combined with the fibular cutting guide can enhance the accuracy of mandible reconstruction and functional outcomes.

Hydrogel: A Potential Material for Bone Tissue Engineering Repairing the Segmental Mandibular Defect.

Free flap surgery is currently the only successful method used by surgeons to reconstruct critical-sized defects of the jaw, and is commonly used in patients who have had bony lesions excised due to oral cancer, trauma, infection or necrosis. However, donor site morbidity remains a significant flaw of this strategy. Various biomaterials have been under investigation in search of a suitable alternative for segmental mandibular defect reconstruction. Hydrogels are group of biomaterials that have shown their potential in various tissue engineering applications, including bone regeneration, both through in vitro and in vivo pre-clinical animal trials. This review discusses different types of hydrogels, their fabrication techniques, 3D printing, their potential for bone regeneration, outcomes, and the limitations of various hydrogels in preclinical models for bone tissue engineering. This review also proposes a modified technique utilizing the potential of hydrogels combined with scaffolds and cells for efficient reconstruction of mandibular segmental defects.

Quantification of the Bimodal Plate-Specific Complication Profile Associated With Reconstruction of Segmental Mandibular Defects With Reconstruction Plate and Soft Tissue Flap: Evidence From Systematic Review.

Reconstruction of segmental mandibular defects with a mandibular reconstruction plate and separate soft tissue flap can be indicated in certain patients. Whilst this technique can provide acceptable results, its exact longevity and timing of associated complications is poorly understood. This study was designed to quantify and plot in time the complication profile associated with this technique of mandibular reconstruction.A search of the Medline and PubMed Central databases was conducted using the terms "Mandibulectomy" and "Reconstruction Plate." Articles reporting total number of plate extrusions and fractures and their postoperative timing were included.Nine articles were included, representing 265 patients with mandibulectomy defects reconstructed using mandibular reconstruction plates. Of these, 135 were male (62%) and 82 were female (38%). The mean age was 59 years. The predominant pathology was oral cavity Squamous Cell Carcinoma (SCC) (80%). Seventy-three patients (28%) experienced complications (mean follow-up: 24 months), with median time to complication of 3 months. Forty-three plate extrusions (16%), 20 plate fractures (8%) and 10 cases of loosened screws (4%) were reported. A bimodal temporal distribution of complications was found.Overall, a plate-specific complication rate of 28% was found, confirming a higher incidence of complications in comparison to osseous free flap reconstruction. These occur over a bimodal time distribution, with extrusion occurring earlier than fracture. interference with speech, swallow and dental rehabilitation, and delay of adjuvant therapy are potential consequences. These findings indicate that patients may be better served by more complex reconstructive procedures, to minimize exposure to a frequent and prolonged complication profile.

Application of transport distraction osteogenesis in reconstruction of mandibular segmental defects

Application of transport distraction osteogenesis in reconstruction of mandibular segmental defects

Reconstruction of Segmental Mandibular Defects with Use of Avascular Fibula Grafts

IntroductionFunctional and cosmetic defects involving the maxillofacial complex may result from traumatic injury, developmental deformities, infections, and iatrogenic injury. Reconstruction of large segmental defects with the use of vascularized free flaps has been considered the gold standard in recent years. There are many logistical and economic considerations with vascularized free flaps, and therefore the authors aim to discuss an alternative. After appropriate patient selection, the use of non-vascularized reconstruction techniques has been shown to be effective. The predominance of current literature centers on the use of iliac crest harvesting, with minimal description of using non-vascularized fibula. The authors will show that a non-vascularized fibula graft should remain a viable alternative in the reconstruction of mandibular defects. Case descriptionsPatient 1 is a 49-year-old male with no significant past medical history, who presented in 2016 with left mandibular fibrous dysplasia. The patient opted for a mandibular shave as initial treatment. However, the lesion recurred in 2019. A left hemimandibulectomy and arthroplasty were performed in March 2020. A vascularized fibula flap was planned in November 2020 to address the patient's ∼13cm defect. During the harvest of the fibula, the vascular pedicle was detached from the flap and determined to be unusable. All soft tissue was then removed from the fibula and secured to the custom fabricated plate and utilized as an avascular graft. The patient underwent an uneventful postoperative course and has shown all signs that the graft is completely viable.Patient 2 is a 52-year-old male with a significant past medical history of tonsillar cancer treated by chemotherapy and radiation in 2009. The patient presented in 2019 with swelling and trismus and was found to have right mandibular chronic osteomyelitis. This was initially treated with debridement and antibiotic therapy. However, the disease process continued, and definitive treatment was performed in June 2020 with a right hemimandibulectomy and arthroplasty. The defect was ∼12cm, and a vascularized fibula flap was selected as treatment in December 2020. However, during anastomosis, there was noted to be a lack of adequate venous flow, and the flap was unable to be salvaged. The fibula was prepped as an avascular graft and fixated to the custom plate. The patient experienced an uneventful postoperative course and has shown no signs of graft failure. DiscussionThe cases presented demonstrate the viability of using a non-vascularized fibula in the reconstruction of segmental mandibular defects. Benefits of using this type of graft include the customization of segments, ease of harvest, and high cortical volume. Literature supports the viability of fibula grafts for future implants.1 Fibula has shown resistance to resorption (∼7.2% after 1 year) in comparison to some reports of ∼50% graft loss with iliac crest. These features as well as the lower failure rates in defects greater than 9cm have popularized the use of vascularized fibula flaps in large mandibular defects. However, the original literature compares vascularized fibula flaps to iliac crest and not avascular fibula. Devireddy et al2 showed the viability of fibula grafts in non-irradiated defects of 6-10cm with consistent success. However, these 2 cases performed by the authors' institution have shown that, even in circumstances of greater than 9cm defects with radiation (Patient 2), an avascular fibula graft may be a viable alternative.

A retrospective study on mandibular reconstruction using iliac crest free flap

PurposeTo assess the availability, success rate and complications of microvascular iliac crest free flap for reconstruction of mandibular segmental defects. MethodsIn this retrospective-descriptive study, we report patients who had undergone segmental mandibular resection for pathologic lesions and received reconstruction with iliac crest microvascular free flap between 2016 and 2019. Clinical and demographic data of all the cases were collected. Success was regarded as complete consolidation of the bone graft in panoramic radiograph. Postoperative complications were defined as major or minor based on the need for intervention. T-test, Kolomogorov_Smirnov, and multivariate analysis were used and the p-value<0.05 was considered to be statistically significant. ResultsOf all 30 patients, 16 were women and 14 were men with an average age of 27.2 years (range 14–40). Patients were followed for 12–60 month (mean: 38.4). One flap was lost due to unsalvageable venous thrombosis. Six other cases had post-op complications while smoking and diabetes were associated with more complications (P = 0.036). Twenty-three patients received primary reconstruction which was more successful than secondary ones (P = 0.003). Osteogenic sarcoma was associated with greater risk of complications (P < 0.01). ConclusionsThe results of this study suggest that iliac crest microvascular free flap serves as a promising option for the reconstruction of mandibular defects, providing excellent contour and acceptable success rate with low donor site morbidity. Future studies will focus on the role of systemic diseases in post-op complications and flap failures.

Comparison of surgical outcomes between primary plate and fibular flap transfer for reconstruction of segmental mandibular defects

Although two ways of reconstruction have been reviewed for a long period, comparison of large sample size with nearly randomized patient selection is rare. Here, we compare the surgical outcomes of these two methods from two large medical institutes. Totally 176 patients were included from two medical centers with different protocols, 62 patients from MacKay Hospital repair defects with fibula flaps using reconstruction plates. Also 114 patients from Kaohsiung ChangGung Hospital treat with reconstruction plates combine anterior lateral thigh flaps, in which 12 cases had secondary fibula flap after plate exposure. Electronic medical records were reviewed retrospectively. Short (3-12 months) and long-term (>12 months) outcomes were evaluated. Short-term evaluation revealed that the secondary fibula had a higher rate of vascular complications (33 vs. 6%, p = .02). Primary fibula had a higher risk of post reconstructive surgical debridement (60 vs. 40%, p = .018). Long-term follow-up revealed radiation therapy significantly worsened bone healing (p = .03). Primary fibula had a lower rate of screw loosening (14.0 vs. 40.3%, p = .002). Radiation therapy did not increase the plate exposure rate among the groups (33 vs. 27%, p = .389). Disease free survival showed no significant difference between two groups (53.1 ± 3.5 vs. 47.8 ± 2.8 months, p = .317). Primary fibula reconstruction should be considered whenever possible to reduce the risk of late complications and simplifies the management after a potential plate exposure. Notably, radiation therapy apparently has no significant effect on plate exposure rate both in ALT or fibula groups.

Immediate Reconstruction of Segmental Mandibular Defects with Non-Vascular Bone Grafts: A 30-Year Perspective

The use of non-vascular bone grafts for immediate mandibular reconstruction remains a controversial topic. The purpose of this study was to identify variables that may influence graft survival based on outcomes over 30 years.

Patient-specific alloplastic endoprosthesis for reconstruction of the mandible following segmental resection: A case series

Reconstruction of mandibular discontinuity defects remains a challenge for maxillofacial surgeons. Despite vascularized free flaps representing the current gold standard for managing such defects, the search continues for other less morbid yet predictable interventions. This study aimed at reviving the idea of alloplastic mandibular endoprosthesis as a treatment modality for reconstruction of segmental mandibular defects following eradication of benign tumors.To reconstruct their segmental mandibular defects, this case series compiled seven patients who received patient-specific titanium implant (PSI) with osseointegrated components and were designed to receive a restoration for dental rehabilitation. The recruited patient population was followed-up for a period of 3–5 years. Three of the seven PSIs failed due to extensive intraoral mucosal dehiscence or persistent extraoral fistulae. Patients with the 4 surviving PSIs enjoyed good results in terms of occlusion, masticatory function, mouth opening as well as pleasing facial esthetics.The described technique represents a viable less morbid alternative to the standard bone grafting techniques for mandibular reconstruction in carefully selected patients. Further studies are needed to modify the PSI design and surface treatment for better outcomes.

Full-staged digital and prosthetic guided protocol for the insertion of dental implants in autogenous free bone grafts after reconstruction of segmental mandibular defects.

This study aims to evaluate the clinical and radiographic outcomes of dental implants, inserted in consolidated free bone grafts; postsegmental mandibular resection, after following a fully guided staged protocol, which established a systematic approach that correlates the grafted bone and the enclosed implants to the undisturbed mandibular segments and the maxillary occlusal plane. Seven patients were enrolled in the study; all were diagnosed for mandibular locally aggressive tumors. All of the patients were subjected to computer-guided segmental mandibular resections, secondary free iliac crest bone graft; aided by computer-guided harvest and prosthetic guidance of the graft positioning and fixation. Finally, the guided bone grafts; after being consolidated, received twenty-nine computer-guided dental implants. By the end of the period of osseointegration, the predetermined criteria of implant success judged the success of twenty-five implants, versus the failure of four implants, with (86.2%) percentage of success. The clinical and radiographic assessments demonstrated sound base bone grafts, which succeeded not only to restore the native mandibular continuity and configuration but also to direct the fair-sized embedded dental implants into favorable coastal locations and axial projections, which influenced a smooth prosthetic rehabilitation.

Survival rate and cervical bone loss of implants placed in non vascularized iliac graft after segmental mandibulectomy

Objective: The purpose of this study was to evaluate the survival rate and the amount of periimplant&#x0D; bone loss in implants placed in free iliac graft following segmental mandible resection.&#x0D; Materials and Methods: Over a 5-year period between 2010 and 2015, nine patients with&#x0D; odontogenic tumors who were candidate for segmental mandible resection were enrolled in this&#x0D; study. Resection defect was immediately reconstructed with non-vascularized iliac graft and 4-6&#x0D; months later 36 implants of 5 different brands were inserted in grafted mandibles. Information&#x0D; regarding implant survival, peri implant bone loss or inflammation for a mean follow up period of&#x0D; 33 months was obtained.&#x0D; Results: One implant was failed out of 36 implants and the cumulative survival rate of implants&#x0D; was 97.2% in this follow up period. There was no sign of peri implant inflammation or gingival&#x0D; recession or BOP in any patients. The cervical bone loss level varied between 0.6 to 12mm (the&#x0D; length of failed implant) with the average of 0.96 mm. The bone loss level of survived implants&#x0D; varied between 0.6to 1.72mm with average of 0.64mm.&#x0D; Conclusion: This study demonstrated that reconstruction of segmental mandibular defect with&#x0D; non vascularized iliac graft followed by dental implant placement is an effective and predictable&#x0D; method to restore oral function.

Patient-Specific Mandibular Reconstruction Plates Increase Accuracy and Long-Term Stability in Immediate Alloplastic Reconstruction of Segmental Mandibular Defects

ObjectivesThe aim of the current study was to evaluate potential differences in the accuracy of mandibular reconstruction and long-term stability, with respect to different reconstructive procedures.MethodsIn total, 42 patients who had undergone primary segmental mandibular resection with immediate alloplastic reconstruction, with either manually pre-bent or patient-specific mandibular reconstruction plates (PSMRP), were included in this study. Mandibular dimensions, in terms of six clinically relevant distances (capitulum [most lateral points], capitulum [most medial points], incisura [most caudal points], mandibular foramina, coronoid process [most cranial points], dorsal tip of the mandible closest to the gonion point) determined from tomographic images, were compared prior to, and after surgery.ResultsDimensional alterations were significantly more often found when conventionally bent titanium reconstruction plates were used. These occurred in the area of the coronoid process (p = 0.014). Plate fractures were significantly (p = 0.022) more often found within the manually pre-bent group than within the PSMRP group (17%/0%).ConclusionThe results suggest that the use of PSMRP may prevent rotation of the proximal mandibular segment, thus avoiding functional impairment. In addition, the use of PSMRP may potentially enhance the long-term stability of alloplastic reconstructions.

Reconstruction of segmental mandibular defects: Current procedures and perspectives.

BackgroundThe reconstruction of segmental mandibular defects remains a challenge for the reconstructive surgeon, from both a functional and an esthetic point of view.MethodsThis clinical review examines the different techniques currently in use for mandibular reconstruction as related to a range of etiologies, including the different bone donor sites, the alternatives to free flaps (FFs), as well as the contribution of computer‐assisted surgery. Recent progress and the perspectives in bone tissue engineering (BTE) are also discussed.ResultsOsseous FF allows reliable and satisfying outcomes. However, locoregional flap, distraction osteogenesis, or even induced membrane techniques are other potential options in less favorable cases. Obtaining an engineered bone with satisfactory mechanical properties and sufficient vascular supply requires further investigations.ConclusionsOsseous FF procedure remains the gold standard for segmental mandible reconstruction. BTE strategies offer promising alternatives.

Immediate Reconstruction of Segmental Mandibular Defects with Non-Vascularized Bone Grafts

Purpose There is long-standing evidence that a segmental mandibular defect greater than 6cm needs to be reconstructed with a vascularized graft, which significantly increases patient morbidity. We challenge this notion. In this study, we determined maximum defect size that can be predictably reconstructed with nonvascularized bone grafts immediately after resection. Methods A retrospective chart review of 34 patients that had mandibular resections for benign pathologies that were immediately reconstructed with particulate marrow grafts were reviewed. The same senior surgeon at a university medical center oversaw all cases. Cohort demographic and descriptive data were obtained, resection size was determined, and statistics were calculated. Results The patient cohort had a mean age of 49 years (standard deviation [SD] = 12.2), and consisted of 16 males and 18 females. Mean follow-up time was 18 months. Diagnoses included 15 (44%) cases of osteomyelitis, 13 (38%) ameloblastomas, 5 (15%) ossifying fibromas, and 1 (3%) histiocytoma. Average resection size of all cases was 8.7 cm (SD = 4.1). Average resection size of successful grafts was 8.1 cm (SD = 3.2). Graft failures measured 12.1 cm (SD = 2.8). When comparing graft success versus failure there is statistical significance (P Conclusions Taken together, these data demonstrate that segmental mandibular resections for benign pathology can be predictably reconstructed using non-vascular grafts up to 8.1Â ± 3.1cm. The morbidity and time of surgery of particulate marrow grafts is significantly less compared with free-flap reconstruction. Furthermore, the course of treatment in these patients is significantly decreased. This facilitates expedited convalescent care and an earlier return to normal form and function.

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

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.