Regions of ilium and fibula providing clinically usable bone for mandible reconstruction: “A different approach to bone comparison”

Abstract

A variety of donor sites are available for mandibular reconstruction. We present here a different way of comparing two commonly-used bone flaps. The lengths of the usable parts in a total of 241 coxal bones, 91 mandibles and 60 fibulas were measured. The mandible was measured from condyle-to-condyle and the harvestable bone length (HBL) and usable (UBL) bone lengths in fibula and ilium were also measured. The bone thickness (BT) in 60 iliac crests was measured in two parallel lines from the anterior superior iliac spine (ASIS) along the iliac crest. The mandible was 32.17 mm shorter in females than in males. The total ilium UBL was 171.12 mm in females and 178.80 mm in males. The mean HBL of the fibula was 22.6 mm shorter in females than in males. However, in some fibulas in both females and males, only 4.2% and 21.1% of the HBL respectively could be used if the ultimate goal was to insert dental implants. We found significant correlations between BT and gender in both fibula and ilium (P≤ 0.05). The ilium offers constant BT throughout the usable bone area with a similar bone length to the fibula. In contrast, the fibula showed variable bone dimensions, so not all of it is clinically usable. This should especially be considered in females when a mandibular reconstruction is planned with the goal of occlusal rehabilitation. Clin. Anat. 29:773-778, 2016. © 2016 Wiley Periodicals, Inc.

Morphometric analysis of paired fibula and mandible for optimal fibular mandibular reconstruction in a Chinese population

“…Fibula could provide adequate length but limited height or bone thickness in comparison with ilium 5 , 16 . Since the vertical height of fibula was shorter than that of native mandible, it was recommended to place transferred fibula on the lower edge of mandible to improve cosmesis, or on the upper edge of mandible to reduce the implant height.…”

“…In addition to height, it was evidenced that fibula showed variable bone dimensions and some sites presented inadequate width for dental implants 5 . A digital imaging study suggested that the width of the central section of fibula was the largest compared with that of lateral malleolus and head of the fibula.…”

“…The height of reconstructed neomandible is significantly lower than that of the original bone, which makes implant-retained prosthetic rehabilitation difficult. It was reported that only 4.2% and 21.1% of the harvestable bone length could be suitable for inserting dental implants in females and males, respectively 5 . Also, as shown in a CT-based study, the cross-sectional morphology of transferred fibulae could be classified into two types including apex and nonapex, and the ridge at the apex was too narrow for dental implants 6 .…”

Introduction of an algorithm for planning of autologous fibular transfer in mandibular reconstruction based on individual bone curvatures

“…Margins for protected spaces may be defined to prevent the method from using bone where harvesting is not permitted. From a clinical perspective, the stability of the ankle joint or the knee would be compromised if too much fibular bone is harvested …”

“…Protected margins at the fibula were set in the present study to 70 mm from both the ankle and knee . This constraint was implemented to only allow clinically feasible transplant sections to be selected, because a literature survey showed common recommendations for protected margins of between 6 and 8 cm …”