Randomized control trial of non-vascularized fibular and iliac crest graft for mandibular reconstruction

Abstract

Background: Mandibular reconstruction of segmental defects caused by trauma or tumor excision is a challenge despite numerous advances in surgical and fixation techniques. Bone grafts from fibula or iliac crest are most frequently used to reconstruct mandible.

Immediate iliac bone graft reconstruction of post ablative defect of benign mandibular pathology - a systematic review

“…Some authors believe that the method of immobilization has a big role to play in the success of the graft, [29] -(32), Okoturo [28] - (10), Schlieve et al [23] - (13), Shirani et al [30] -(4), Obiechina et al [25] - (13), Agrawal et al [3] - (8) 80 (74.8)…”

“…Okoturo [28] -(4), Schlieve et al [23] - (2), Obiechina et al [25] - (3) 9 (8.4) Odontogenic myxoma/fibromyxoma Schlieve et al [23] -(2), Okoturo [28] - (2), Obiechina et al [25] - (2), Shirani et al [30] - (1) 7 (6.5) Odontogenic keratocyst Shirani et al [30] - (1), Agrawal et al [3] - (1) 2 (1.9)…”

“…Obiechina et al [25] - (2) 2 (1.9) Cementoblastoma Schlieve et al [23] - (1) 1 (0.9) Odontogenic cyst Okoturo [28] - (1) 1 (0.9) Central giant cell granuloma Okoturo [28] - (1) 1 (0.9) Spindle cell tumor Shirani et al [30] - (1 ) 1 (0.9) Arteriovenous malformation Schlieve et al [23] - (1) 1 (0.9) Osteoblastoma Schlieve et al [23] - (1) 1 (0.9) Osteomyelitis Agrawal et al [3] - (1) 1 (0.9) Total 107 (100) [23] -(2), Obiechina et al [25] -(1), Agrawal et al [3] -(3), Simon et al [29] -(2), Olusanya et al [19] - (2) Wound dehiscence 5 (31.3) Okoturo [28] -(2), Agrawal et al [3] -(1), Olusanya et al [19] - (2) Orocutaneous fistulation 1 (6.2) Okoturo [28] - (1) Total 16 (100) Although a number of the studies in this review employed rigid fixation of the graft with the use of plates and the authors claiming it as one of the main factors for graft success. Few of the studies due to non-affordability of plates by patients employed the use of stainless steel wires for immobilization with good outcomes even in long defect spans.…”

“…On the part of the surgeon the challenge is that of reconstruction to restore the normal anatomic form and function of the mandible. [3,4] Various reconstructive options that have been documented in published literature include autograft, xenograft and alloplast.…”

“…[3,17] However the ilium remains the workhorse with most authors due to its relative advantages like ease of harvest, good osseous bulk, contour, favorable bio-mechanics and sufficient width for implant placement.…”