Nonvascularized bone grafts for segmental reconstruction of the mandible--a reappraisal.
OBJECTIVE
To evaluate the success rate and complications of segmental mandibular reconstructions with autogenous nonvascularized iliac crest bone grafts, and to refine treatment strategies.


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 necessary.
van Gemert
Johannes T M
JT
Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, The Netherlands. j.t.m.vangemert@umcutrecht.nl
van Es
Robert J J
RJ
Van Cann
Ellen M
EM
Koole
Ron
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D002680:Chin / Q000601:surgery; D005260:Female; D006801:Humans; D007085:Ilium / Q000601:surgery; D019248:Jaw Fixation Techniques; D008297:Male; D008334:Mandible / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000534:rehabilitation / Q000601:surgery*; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013529:Surgical Wound Dehiscence; D013530:Surgical Wound Infection; D016896:Treatment Outcome; D055815:Young Adult