title: Distraction osteogenesis versus fibula free flap for mandibular reconstruction after gunshot injury: socioeconomic and technical comparisons.
abstract: BACKGROUND
  Since the birth of maxillofacial surgery, ballistic injuries are a real challenge for surgeons. For more than 20 years, fibula free flap (FFF) became the criterion standard for mandibular reconstructions. But FFF is not always the perfect answer for mandibular reconstruction, and a technique named distraction osteogenesis (DO) was raised. The purposes of this study are to estimate the financial cost and reattempt for the patient each techniques in our experience to determine the best-choice criteria for mandibular reconstruction after gunshot injury.
  
  
  METHODS
  We performed a retrospective study over the last 15 years, including 15 patients with a mandibular ballistic injury. Ten patients were treated with FFF, and 5 with DO. We evaluated the complications and morbidity encountered with each technique. We also decided to estimate the cost of different rehabilitations, including the cost of the device and hospitalization.
  
  
  RESULTS
  In our study, the global cost of the DO protocol appears as not more expensive than the FFF one. Postoperative complications encountered during the FFF protocols were related to donor-site morbidity. The DO patient had pseudoarthrosis, mucosa irritation, or local infection.
  
  
  CONCLUSIONS
  Our study demonstrated both the economic and technical interest of DO compared with the FFF for mandibular reconstruction. Thus, nowadays, DO appears as an alternative to the FFF for mandibular reconstruction, the main decisional criterion being the evaluation of the tissues dilapidated during the initial traumatism, but social environment of the patient shall also be considered.
authors.affiliation: Univ Lille Nord de France, †Oral and Maxillofacial Department, Roger Salengro Hospital, Lille, France. thomaswojcik4@gmail.com
authors.forename: Thomas
authors.initials: T
authors.lastname: Wojcik
authors.forename: Joel
authors.initials: J
authors.lastname: Ferri
authors.forename: Sandrine
authors.initials: S
authors.lastname: Touzet
authors.forename: Thomas
authors.initials: T
authors.lastname: Schouman
authors.forename: Gwenael
authors.initials: G
authors.lastname: Raoul
mesh_terms: D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000191:economics / Q000379:methods*; D005360:Fibula / Q000637:transplantation*; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008338:Mandibular Injuries / Q000000981:diagnostic imaging / Q000191:economics / Q000601:surgery*; D008875:Middle Aged; D019857:Osteogenesis, Distraction / Q000191:economics / Q000379:methods*; D011183:Postoperative Complications; D011862:Radiography, Panoramic; D013524:Surgical Flaps / Q000098:blood supply / Q000191:economics; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging / Q000191:economics / Q000601:surgery*