Reconstruction of mandibular defects - clinical retrospective research over a 10-year period -

Abstract

BackroundFunctional and cosmetic defects in the maxillofacial region are caused by various ailments and these defects are addressed according to their need. Simplicity of procedure, intact facial function and esthetic outcome with the least possible donor site morbidity are the minimum requirements of a good reconstruction. Oro-mandibular reconstruction, although a challenge for the head and neck reconstructive surgeon, is now reliable and highly successful with excellent long-term functional and aesthetic outcomes with the use of autogenous bone grafts. Reconstruction of trauma- or mandibular oncologic defects with bony free flaps is considered the gold standard. However the the optimal reconstruction of mandibular defects is still controversial in regards to reconstructive options which include the donor site selection and the timing of surgery. The purpose of this study was to determine the outcome of different osseous reconstruction options using autogenous bone grafts for mandibular reconstructions.MethodsThis study was carried out on 178 patients with mandibular bone defects. They were reconstructed with autogenous bone grafts from different donor sites. At post operative visits they were evaluated for functional and cosmetic results.ResultsThe success rate found in this study was around 90%. Only 7.6% of the cases showed poor results regarding facial contours and mouth opening. All other patients were satisfied with their cosmesis and mouth opening at the recipient sites was in the normal range during last follow-up visits. Donor sites were primarily closed in all cases and there was no hypertrophic scar.ConclusionBased on this study, autogenous bone grafts are a reliable treatment modality for the reconstruction of mandibular bone defects with predictable aesthetic and functional outcomes. As the free vascularized fibular flap has the least resorption and failure rate, it should be the first choice for most cases of mandiblular reconstruction.

A novel bioactive vitroceramic presents similar biological responses as autogenous bone grafts

“…In this way, sometimes blood clot itself resulting from the local bleeding is enough to heal the tissue. However, larger defects requires the use of devices and materials in order to fill the gap between the bone fragments while healing occurs, such as autogenous [1][2][3], alogenous [4] and xenogenous bone grafts [5][6][7], or synthetic biomaterials, among many other options [8][9][10].…”

Immediate Free Iliac Bone Graft After Nonsegmental Mandibular Resection and Delayed Implant Placement

“…[1][2][3][4][5][6] Surgeons may prefer to harvest a nonvascular iliac graft if the size of the defect is smaller, the continuity of the mandible has not been interrupted, the nature of the tumor is nonmalignant, and/or radiation therapy was not necessary to control the tumor. [7][8][9] The degree of resorption of nonvascularized iliac bone grafts is an important consideration when treatment planning includes hard tissue reconstruction and dental implant restoration. Several studies have indicated that nonvascularized onlay iliac block grafts may have more resorption than intramembranous bone graft such as ramus, symphysis, and calvaria.…”

Pediatric Ameloblastic Fibro-Odontosarcoma of the Mandible: A Challenge of Diagnosis and Treatment

“…Among the optional donor sites are the scapula, iliac bone, and the fibula, with the latter being the most popular because of its major advantages over the other flaps, as described elsewhere. [6][7][8] This reconstruction modality has been used successfully in pediatric patients. 9,10 Compared with mandibular reconstruction in adults, in whom growth is not an issue and the intermaxillary relations are already mature, it is of great importance to understand the effect such reconstructions may have on the oromandibular complex in young patients before and during the growth phases.…”

“…This method is normally recommended for resections that do not cross the midline. [4][5][6][7][8][9][10][11][12][13] In the present case, the resection did cross the midline, and the mirror duplicate left a gap between the second incisors. This gap was bridged using the maxillary dentition as a positioning guide for the lower alveolar segment and the chin (Fig 3D).…”