MANDIBULAR RECONSTRUCTION ALGORITHM USING ILIAC CREST BONE GRAFT AND VASCULARISED FIBULA FLAP
Mandibular reconstruction algorithm using ICB and VFF
Abstract
Background: The study aim to describe the science behind a novel reconstructive algorithm that dictates the reconstruction and outcome of a benign mandibular defect based on the potential impact from a resected vertical ramus, by presenting cases using either iliac crest bone grafts (ICB) or vascularised fibula flaps (VFF).
Methodology: This is a retrospective study of mandibular reconstruction. We followed a reconstruction algorithm briefly described as, ICB indicated for lateral and hemi-mandibular defect and VFF for antero-lateral or bilateral-defect. Data collated included demographic, histopathology, types of mandibulectomy or defects, types of reconstruction, clinical outcomes and complications. Clinical outcomes were evaluated in terms of function and aesthetics, and assessed using post-operative panoramic images and standardized questionnaire. Statistical analysis was by percentages, mean, and post-operative complication predictors (multivariate-analysis).
Results: Thirty-five subjects were recruited for this study, with type II Schultz et al. classification being the prevalent mandibular defect in 16 (46%) cases. Twenty-three out of 35 cases underwent ICB while 12 out of 35 cases underwent VFF reconstruction. Functional-aesthetic outcomes were adjudged good/acceptable in all cases. 70% of cases in both groups were free of complications with infection being the highest complication in the ICB group and wound dehiscence in the VFF groups. While there was a causal relationship between defect size and complications / outcome, our analysis showed defect size (p<0.06) and bone length (p<0.12) to be statistically insignificant with respect to their association with increased complication.
Conclusion: In conclusion, this reconstructive algorithm for the reconstruction of benign mandibular defects is simple, effective, and broadly applicable especially in limited resource areas.
