Reconstruction of mandibular defects using nonvascularized autogenous bone graft in nigerians

Abstract

Objectives: The aim of this study is to evaluate the success rate and complications of mandibular reconstruction with nonvascularized bone graft in Ile-Ife, Nigeria.

Patients and methods: A total of 25 patients who underwent reconstruction of mandibular discontinuity defects between January 2003 and February 2012, at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife constituted the study sample. Relevant information was retrieved from the patients' records. This information include patients' demographics (age and sex) as well as the type of mandibular defect, cause of the defect, type of mandibular resection done, source of the bone graft used, and the method of graft immobilization. Morbidity associated with the graft procedures were assessed by retrieving information on graft failures, length of hospital stay following surgery, rehabilitation device used and associated graft donor and recipient site complications.

Result: There were 12 males and 13 females with a male:female ratio was 1:1.1. The age of the patients ranged from 13 to 73 years with a mean age for males 32.7 ± standard deviation (SD) 12.9 and for females 35.0 ± SD 17.1. Jaw defect was caused by resection for tumours and other jaw pathologies in 92% of cases. Complete symphyseal involvement defect was the most common defect recorded 11 (44%). Reconstruction with nonvascularized rib graft accounted for 68% of cases while iliac crest graft was used in 32% of the patients. Successful take of the grafts was recorded in 22 patients while three cases failed. Wound dehiscence (two patients) and postoperative wound infection (eight patients) were the most common complications recorded.

Conclusion: The use of nonvascularized graft is still relevant in the reconstruction of large mandibular defects caused by surgical ablation of benign conditions in Nigerians. Precise surgical planning and execution, extended antibiotic therapy, and meticulous postoperative care contributed to the good outcome.

Keywords: Mandibular defect; mandibular reconstruction; nonvascularized bone graft.

Figure 1

A schematic diagram of the mandible illustrating the defects described in Table 1

Figure 2

A patient with mandibular central ameloblastoma. Note the jaw expansion involving the right body and angle region

Figure 3

Three-dimensional computed tomography scan of mandibular ameloblastoma showing bony destruction extending from the right angle of the mandible to the first premolar region

Figure 4

Patient with hypertrophic scar after mandibular reconstruction

Figure 5

Mandibular reconstruction with autogenous iliac crest graft. Note the graft in place and immobilized with a 2.4 mm KLS Martins right angle recon plate and screws

Figure 6

Patient 3 months after mandibular reconstruction