A two-year audit of non-vascularized iliac crest bone graft for mandibular reconstruction: technique, experience and challenges

Abstract

ObjectivesNon-vascularized iliac crest bone graft (NVIBG) is a known treatment option in mandibular reconstruction following jaw resection, but no documented review of patients treated with NVIBG exists for northern Nigeria. The experience and technique from a Nigerian tertiary hospital may serve as baseline data for comparison and improvement of practice for other institutions.Materials and MethodsA retrospective review of medical records and patient case files from January 2012 to December 2013 was undertaken. All case files and other medical records of patients who had reconstruction with NVIBG for benign or malignant lesions with immediate or delayed reconstruction were selected for review.ResultsTwenty patients had mandibular reconstruction with NVIBG during the study period. Two patients were excluded because of incomplete medical records. Eighteen patients' (male=14, female=4) records were reviewed. Their ages ranged from 13 to 62 years (mean 26.0±10.6 years). Indications for NVIBG included jaw tumors (n=16; 88.3%), jaw cyst (n=1; 5.6%) and gunshot injury (n=1; 5.6%). Jaw tumors seen were ameloblastoma (n=15; 83.3%) and osteosarcoma (n=1; 5.6%). Treatments done were mandibular resection with condylar resection (n=7; 38.9%), mandibular segmental resection (n=10; 55.6%) and subtotal mandibulectomy (n=1; 5.6%). Patients' postoperative reviews and radiographs revealed good facial profile and continued bone stability up to 1 year following NVIBG.ConclusionNVIBGs provide an acceptable alternative to vascularized bone grafts, genetically engineered bone, and distraction osteogenesis for mandibular reconstruction in resource-limited centers.

Ameloblastoma uniquístico intramural, reconstrucción tardía y rehabilitación con implantes dentales. Reporte de caso

“…Por tal motivo, su empleo es favorecido sobre sitios como las costillas, calvaria, escápula y fíbula en la reconstrucción mandibular (16). En este sentido, Omeje et al (19) resaltan el éxito del uso de injertos de CI en defectos óseos entre 4 cm y 12 cm, con una baja tasa de reabsorción, esto puede estar relacionado con el uso de fijación rígida del injerto mediante placas, la administración profiláctica de antibióticos y su empleo en el postoperatorio, así como la naturaleza benigna de las lesiones tratadas.…”

“…En particular, la CI posterior provee gran cantidad de tejido óseo (alrededor de 100ml) con las mismas propiedades fisiológicas que la CI anterior; asimismo, su proximidad a la superficie corporal facilita la recolección del injerto, se produce menor sangrado que en la técnica para la CI anterior, con la disminución del dolor posoperatorio y disturbios en la marcha, además de una posible reducción en la estancia hospitalaria (18,19).…”

Mandibular reconstruction using free vascularized iliac crest grafts and dental implants

“…The treatment of malignant or benign tumors that affect the mandible involves in the majority of the cases the presence of a significant bone defect that may interfere with the patient’s quality of life [ 1 ]. Due to the esthetic and functional importance of the mandible, its reconstruction is a major objective in the treatment of mandibular bone defects [ 2 ]. The aim of mandibular bone reconstruction is to obtain adequate bone amount for the placement of dental implants, for optimal muscle insertion, and to maintain the integrity of the inferior alveolar nerve where possible [ 3 ].…”

“…The iliac crest was initially used as a non-vascularized graft. The advantage of this type of graft was the increased amount of bone tissue available for reconstruction, as well as the low cost of this procedure [ 2 ]. A disadvantage of this type of reconstruction is that it has no vascularization of its own, which has an unfavorable effect on the metabolism and volume stability of the bone graft [ 5 , 6 ].…”

Reconstruction of posttraumatic and postoperative defects of lower jaw

“…Одной из наиболее актуальных в реконструкции дефектов нижней челюсти является проблема восстановления ее анатомического оптимума и функциональной целостности [1]. Дефекты нижней челюсти могут быть вызваны травмой, дисплазией тканей, атрофией, постлучевым некрозом, доброкачественным или злокачественным новообразованием [2][3][4][5].…”