Management of Massive Mandibular Fibrous Dysplasia with Radical Excision and Different Immediate Reconstructive Modalities: Case Series Report

Abstract

Purpose: To review and represent three different mandibular reconstruction modalities following surgical treatment of massive mandibular fibrous Dysplasia (MMFD).

Methods: The present retrospective case series study was conducted on 24 patients who had MMFD and treated via resection and immediate reconstruction at Al-Azhar University Hospitals, Egypt. Patients were divided into three groups according to the grafting procedure. Group I patients were grafted with iliac bone graft (IBG), group II patients were grafted with IBG and bone marrow aspirate concentrate (BMAC), while group III patients were grafted with free vascularized fibula graft (FVFG). Postoperative clinical and radiographic assessments were performed immediately, at 6 months, 12 months and 2 years to evaluate lesion recurrence and bone graft resorption. Other study variables included assessment of postoperative wound dehiscence, infection rate, amount of edema, and facial bone contour.

Results: The parameters of the clinical analysis showed non-statistically significant differences among all groups. Postoperative wound healing was clinically uneventful in all groups, except for two cases of wound dehiscence in group I (8.3%) and one case in group III (4.2%). Most patients had appropriate postoperative facial contour, and adequate facial symmetry. The radiographic measurements revealed a highly statistically significant difference between group I and II at 12 months, and two years, without any statistically significant difference between group II and III.

Conclusion: MMFD surgical defect should be repaired for function and cosmetics aims especially in young adult patients. The findings of the present study have shown that when compared to traditional IBG alone or FVFG, the use of autogenous IBG with BMAC injection produces a favorable outcome with few difficulties.

Keywords: BMAC; Fibrous dysplasia; Free vascularized fibula graft; IBG s; Iliac crest.

Fig. 1

Preoperative clinical photograph for a patient with massive monostatic fibrous dysplasia at the right ramus area of the mandible

Fig. 2

Reconstructed computed tomogram photograph showing: a Preoperative massive monostatic fibrous dysplasia at the right ramus area of mandible extending to the inferior border, b one year postoperative reconstructed mandible with iliac crest bone graft

Fig. 3

Preoperative clinical photograph for patients with massive monostatic fibrous dysplasia at the anterior area of mandible

Fig. 4

Intraoperative clinical photograph showing lesions after resection

Fig. 5

Postoperative OPG photograph showing fibula bone graft reconstructed the anterior mandible and implant rehabilitation after one year

Fig. 6

Postoperative intraoral clinical photographs showing the reconstructed mandible rehabilitation with fixed implant supported restorations