Iliac Crest Bone Grafting for Mandible Reconstruction: 10-Year Experience Outcomes
To evaluate 10-year patient data related to mandibular reconstruction with non-vascularized iliac crest bone grafts at a tertiary academic center.
Patients and methods:
Retrospective analysis on patients who underwent mandibular reconstruction with non-vascularized bone graft between 2001 and 2011. For study pirposes, patients were divided into 2 groups: 1) Continuity defects: True lateral (body and/or ramus), symphysis involvement or complete symphysis, and 2) Non-continuity defects. Data was analyzed for variations in gender, age, dental status, etiology of defect, size and site of the defect and medical comorbidities. Surgical factors analyzed included type of reconstruction (immediate versus delayed), surgical approach, method of graft fixation, use of maxillomandibular fixation and need for soft tissue grafting. Complications were classified as major, when requiring return to the hospital and/or operating room; or minor when only required medical treatment or minor surgery in office setting. Success was defined as maintenance of over 50% of the graft, bone continuity for continuity defects and absence of infection. Bone consolidation on radiographs was examined in 3 time intervals: Immediate post surgery (T1), 2-3 months after (T2), Last follow up (T3/LFU).
Results:
A total of 59 (37 males and 22 females) patients met criteria. 31 patients has continuity defects whereas 28 had non-continuity type. The age range was 13-60 years. Six patients were edentulous. 49% of patients were reconstructed for ablative defects related to benign pathology, while others included trauma, malignancy and other conditions. In group 1, 23 patients had true lateral defects, whereas 8 had complete symphysis involvement. There was an overall 87% success rate in this group, with 95% success for true lateral defects (n=1 failed cases) and 100% success in the symphyseal group for defects less than 9 cm. However, when all sizes were considered (including over 9 cm defects), the mean success rate was 62% (n=3 failed cases). Group 2 had an 82.1% success rate with 5 failed cases. Major complications included seroma (n = 1) requiring surgical drainage, and infection (n=3) requiring return to debridement and/or graft removal. Minor complications included dehiscence of recipient (n=7) and donor (n=1) sites, persistent hip pain (n=3), transient paresthesia (n=15) and temporary cranial nerve VII injury (n=7).
Conclusions:
NVBGs are highly successful in mandibular continuity reconstruction for non-cancer patients and should be considered as first choice for defects less than 9 cm, irrespective of symphysis involvement. They may be less predictable for defects larger than 9 cm but can be considered in these cases.
References:
- Li Z, Zhao Y, Yao S, Zhao J, Yu S, Zhang W: Immediate reconstruction of mandibular defects: A retrospective report of 242 cases. J Oral Maxillofac Surg 65:883-890, 2007
- Van Gemert J, Van Es R, Van Cann E, Koole R: Nonvascularized bone grafts for segmental reconstruction of the mandible - a reappraisal. J Oral Maxillofac Surg 67: 1446-1452, 2009