Mandibular reconstruction with non-vascularized bone graft in a double bridging technique
Main Article Content
Keywords
Mandibular Defect, Bone Graft, Reconstruction Plate, Iliac Crest, Rib
Abstract
Background: Reconstruction of the mandible following tumor resection or trauma can be challenging due to associated functional and esthetic problems. Various options have been described in the literature, but non-vascularized bone graft remain a viable option in middle- and low-income countries, Nigeria inclusive. We hereby report our experience with the use of non-vascularized bone graft with mandibular reconstruction plates in a double bridging technique for mandibular reconstruction in our institution.
Methodology: Patients who had mandibular defect reconstruction with non-vascularized bone graft between January 2012 and December 2021 were included in this study. Grafts were harvested from either the rib or contralateral iliac crest and secured with mandibular reconstruction plate and screws in a double bridging technique. Patients were followed for a minimum of 12 months and outcomes such as the level of patients’ satisfaction with appearance, graft take, bony continuity and complications were assessed and analyzed.
Result: Twenty eight patients comprising 18 males and 10 females [M:F 1.8:1] had mandibular defect reconstruction with double bridging technique during the study period. Donor site distribution revealed that 64.3% [n=18] had their grafts harvested from the iliac crest while the remaining 10 [35.7%] were taken from the rib. Ameloblastoma [75%, n=21] was the commonest lesion necessitating resection of the mandible amongst the subjects. The follow up result showed that appearance was satisfactory in 25 patients [89%], graft take/ restoration of bony continuity in 27 patients [96%], graft infection occurred in 2 patients [7.1%] while only one case of graft failure was established [3.6%]
Conclusion: A combination of non-vascularized bone graft with reconstruction plate in a bridging technique is a viable option for mandibular reconstruction in a resource-limited setting.
References
2. Obiechina AE, Ogunlade SO, Fasola AO, Arotiba JT. Mandibular segmental reconstruction with iliac crest. West Afr J Med. 2003; 22(1):46-49.
3. Abukawa H, Shin M, Williams WB, Vacanti JP, Kaban LB, Troulis MJ. Reconstruction of mandibular defects with Autogenous tissue engineered bone. J Oral Maxillofac Surg 2004; 62:601-606.
4 Urken ML. Composite free flap in oromandibular reconstruction. Arch Otolryngol Head Neck Surg. 1991; 117:724-732.
5 Ndukwe KC, Aregbesola SB, Ikem IC, et al. Reconstruction of Mandibular Defects Using Nonvascularized Autogenous Bone Graft in Nigerians. Nigerian Journal of Surgery. 2014; 20(2):87-91.
6 Okojie VN, Obimakinde OS, Arotiba JT, Fasola AO, Ogunlade SO, Obiechina AE. Mandibular defect reconstruction with non-vascularized iliac crest bone graft. Niger J Clin Pract. 2012; 15:224-227.
7 Herford AS. Use of a plate-guided distraction device for transport distraction osteogenesis of the mandible. J Oral Maxillofac Surg. 2004; 62:412-420.
8 Braimah RO, Ibikunle AA, Abubakar U, Taiwo AO, Oboirien M, Adejobi FA, et al.. Mandibular reconstruction with autogenous non-vascularised bone graft. Afr Health Sci 2019; 19 (3):2768-2777.
9 Tidstrom KD, Keller EE. Reconstruction of mandibular discontinuity with Autogenous iliac bone grafting: Report of 34 consecutive patients. J Oral Maxillofac Surg. 1990; 48(4):336-346.
10 Arotiba JT, Obimakinde OS, Ogunlade SO, et al. An audit of mandibular defect reconstruction methods in a Nigerian Tertiary Hospital. Niger Postgrad Med J. 2011; 18:172-176.
11 Kumar BP, Venkatesh V, Kumar KAJ, Yadav BY, Mohan SR. Mandibular Reconstruction: Overview. J. Maxillofac. Oral Surg. 2016; 15(4):425-441.
12 Hull W, Miloro M, Kolokythas A. Is immediate reconstruction of the mandible with non-vascularized bone graft following resection of benign pathology a viable treatment option? J Oral Maxillofac Surg 2015; 73:541-549.
13 Pogrel MA, Podlesh S, Anthony JP, Alexander J. A comparison of vascularized and non vascularised bone grafts for reconstruction of mandibular continuity defects. J Oral Maxillofac Surg 1997; 55:1200-1206.
14 Aajum S, Khan NA, Ahmad M. Treatment outcomes of reconstruction with iliac bone graft and rib graft in patients with mandibular defects. Pakistan Oral & Dental Journal.2013; 33(3):423-425.
15 Urken ML, Weinberg H, Vickery C, Buchbinder D, Lawson W, Biller HF. Oromandibular reconstruction using microvascular composite free flaps: report of 71 cases and a new classification scheme for bony, soft tissue, and neurologic defects. Arch Otolaryngol Head Neck Surg 1991; 117:733-744.
16 L.B. Moura, P.H.de A.Carvalho, C.B.Xavier, L.K.Post1, M.A.Torriani, M.Santagata, O.L.Chagas Junior. Autogenous non-vascularized bone graft in segmental mandibular reconstruction: a systematic review. Int. J. Oral Maxillofac. Surg. 2016; 45(11):1388-1394. http://dx.doi.org/10.1016/j.ijom.2016.05.004.
17 Omeje K, Efunkoya A, Amole I, Akhiwu B, Osunde D. A two-year audit of non-vascularised iliac crest bone graft for mandibular reconstruction: technique, experience and challenges. K Korean Assoc Oral Maxillofac Surg, 2014; 40:272-277.
18 Ogunlade SO, Arotiba JT, Fasola AO. Autogenous cortico-cancellous iliac bone graft in reconstruction of the mandibular bone defect: point of technique. Afr J Biomed Res. 2010; 13:157-160.
19 Bai XF, Wushou A, Zheng J, Li G. An alternative approach for mandible reconstruction. J Craniofac Surg 2013; 24(2):195–198. http://dx.doi.org/10.1097/SCS.0b013e3182802269
20 Hayden RE, Mullin DP, Patel AK. Reconstruction of the segmental mandibular defect: current state of the art. Curr Opin Otolaryngol Head Neck Surg 2012; 20:231–236. http://dx.doi.org/10.1097/MOO.0b013e328355d0f3
21 Alfotawi R, Ayoub A. Reconstruction of maxillofacial bone defects: Contemporary methods and future techniques. Am J Adv Med Sci. 2014; 2(1):18-27.
22 Sajid MA, Warraich RA, Abid H, et al. Reconstruction of mandibular defects with autogenous bone grafts:a review of 30 cases. J Ayub Med Coll Abbottabad. 2011; 23:82-85.
23 Donkor P, Bankas DO, Boakye G, Ansah S, Acheampong AO. The use of free autogenous rib grafts in maxillofacial reconstruction. Ghana Medical Journal. 2006; 40(4):127-131.
24 August M, Tompach P, Chang Y, Kaban L. Factors influencing the long term outcome of mandibular reconstruction. J Oral Maxillofac Surg. 2000; 58:731-737. PubMed.
25 Egyedi P. Wound infection after mandibular reconstruction with autogenous graft. Ann Acad Med Singapore 1986; 15:340-345.
26 Chiapasco M, Colletti G, Romeo E, Zaniboni M, Brusati R. Long-term results of mandibular reconstruction with autogenous bone grafts and oral implants after tumor resection. Clin Oral Implants Res 2008; 19:1074–1080. http://dx.doi.org/10.1111/j. 1600-0501.2008.01542.
27 Van Germet JT, Van Es RJ, Van Cann EM, Koole R. Nonvascularized bone grafts for segmental reconstruction of the mandible: a reappraisal. J Oral Maxillofac Surg 2009; 67:1446–1452. http://dx.doi.org/ 10.1016/j.joms.2008.12.052.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This is an open-access journal and articles are distributed under the terms of the Creative Commons Attribution Non-Commercial Share-Alike License 4.0. This licence allows users to download and share, remix, tweak and build upon the article for non-commercial purposes, so long as the original authorship is acknowledged and the new creations are licensed under identical terms.