Nonvascularized Bone Grafting for Mandibular Reconstruction

Abstract

This retrospective study analyzes the long-term results and complications of mandibular reconstruction with nonvascularized bone grafts (NVBGs) and suggests refinements. A total of 166 patients underwent mandibular ablation and primary reconstruction between June 1990 and August 2009, of which 101 were NVBGs, 27 were vascularized bone grafts, and 38 were with functional plate reconstruction. Eighty-seven of 101 patients undergoing NVBG, having all records and followed up for a minimum of 12 months, were included in this study. The analysis criteria included site of defect, surgical approach, method of graft fixation, bony continuity and stability, presence or absence of infection, aesthetic and functional prosthetic rehabilitation, donor-site morbidity, and clinical and radiological changes in the reconstructed area.The overall success with NVBGs in our study was 77 (88.5%) of 87. We used ilium in 68 cases (78.16%), fibula in 16 cases (18.39%), and rib in 3 cases (3.44%). Ten cases (11.5%) showed complete failure due to infection (7 cases) and resorption (3 cases).Nonvascularized bone grafts could be used judiciously for reconstruction of selective mandibular resection defects where there is not much of soft tissue loss, or where 2-layer watertight closure can be achieved intraorally and extraorally. Where only a single-layer intraoral closure is anticipated, either additional soft tissue should be brought submucosally or there should not be extraoral-intraoral communication even during surgery. Also precise patient selection, surgical planning, and execution with meticulous nursing care are keys to success.

Evaluation of Non-vascular Fibula Graft for Mandibular Reconstruction

“…Their ability to report at an early stage of the disease and for frequent follow-up is limited [1]. Other factors like, increased intra-operative time and post operative stay, increased age and compromised medical condition of the patient are against micro vascular grafting.…”

“…In our study we have done immediate reconstruction and 7 days of antibiotic therapy for every patient which resulted in optimum results. Gadre et al [1] suggested using a stay suture of nonresorbable material to fix the soft tissue to the graft or hardware reduces the dead space, hematoma formation and prevents development of additional weight beneath the reconstruction. This aids in reduction of pull and drag on the intraoral suture line and thus the dehiscence rate decreases.…”

“…However there was no mucosal dehiscence. A 2-layer watertight intraoral closure, thorough irrigation with povidone-iodine and saline solution before graft placement, and use of suction drain both on buccal and lingual sides of the graft have been suggested as a mode of prevention [1].…”

“…These need to be addressed according to their extent and severity by ablative surgery of mandible like segmental resection and hemimandibulectomy. These discontinuity defects often severely compromise the mastication, deglutition, speech, protection of airway, and facial aesthetics which makes mandibular reconstruction not only desirable but also essential [1].…”

“…Thus nonvascularised bone grafts are still a reasonable option for mandibular reconstruction in the developing world and can be used for primary reconstruction of mandibular defects due to benign pathologies [1]. Further functional rehabilitation with implants and removable prosthesis can be done after 6 weeks of reconstruction.…”