Nonvascularized Bone Grafts for Segmental Reconstruction of the Mandible—A Reappraisal

van Gemert, Johannes T.M.; van Es, Robert J.J.; Van Cann, Ellen M.; Koole, Ron

doi:10.1016/j.joms.2008.12.052

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Volume 67, Issue 7 , Pages 1446-1452, July 2009

Nonvascularized Bone Grafts for Segmental Reconstruction of the Mandible—A Reappraisal

Presented at the XIXth Congress of the European Association for Cranio-Maxillofacial Surgery, Bologna, Italy.

Johannes T.M. van Gemert, DMD, MD
- Consultant, Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, The Netherlands
- Address correspondence and reprint requests to Dr van Gemert: Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
Robert J.J. van Es, DMD, MD, PhD
- Consultant, Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, The Netherlands
Ellen M. Van Cann, DMD, MD, PhD
- Consultant, Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, The Netherlands
Ron Koole, DMD, MD, PhD
- Professor, Head of the Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, The Netherlands

Purpose

To evaluate the success rate and complications of segmental mandibular reconstructions with autogenous nonvascularized iliac crest bone grafts, and to refine treatment strategies.

Patients and Methods

Seventy-four patients with segmental mandibular defects were included. Malignant lesion, immediate reconstruction, smoking habit, radiotherapy, site of the defect, surgical approach, and method of graft fixation were analyzed as factors of influence on success. Success was defined as maintenance of bone continuity and stability, and absence of infection 1 year after reconstruction upon clinical and radiographic examination. Complications were divided into recipient and donor-site complications and classified as minor or major. The reconstruction was considered functionally complete if prosthetic rehabilitation was accomplished or if there was a sufficient remaining dentition for mastication.

Results

In 56 (76%) patients, the initial reconstruction was successful. Multivariate analyses showed that symphyseal involvement (SI) and intraoral approach (IA) were significantly associated with failure (P_SI = .022, P_IA = .038) and major recipient-site complications (P_SI = .022, P_IA = .038). Thirty-two (43%) patients showed complications in the first postoperative year: 27 recipient-site complications and 6 donor-site complications. Nineteen (70%) recipient-site complications were classified as major. The reconstruction was functionally complete in 48 (86%) of the 56 patients with a successful initial reconstruction.

Conclusions

Nonvascularized iliac crest bone grafts for segmental reconstruction of the mandible is the method of choice on the condition that the defect is truly lateral and only an extraoral approach is used. In these cases, microvascular tissue transfer is not necesary.