Computer-assisted Secondary Reconstruction of Mandibular Continuity Defects Using Non-Vascularized Iliac Crest Bone Graft Following Oral Cancer Resection

Abstract

The surgical treatment of oral cancers can lead to continuity defects of the mandible. However, microvascularized free-tissue transfer has several limitations, including issues with morbidity of the donor site, complications and a poorly fitted bone geometry. Thus, non-vascularized iliac crest bone grafting, an established conventional technique, remains a feasible alternative for the reconstruction of mandibular continuity defects following advanced oral cancer resection. The purpose of this study was to retrospectively evaluate treatment outcomes using computer-assisted secondary reconstruction of mandibular continuity defects through non-vascularized iliac crest block grafts over a 5-year period and to explore clinical limitations. A total of 11 consecutive advanced oral cancer patients (6 males and 5 females; mean age, 66.6 years) were included in this study. Participants that received computer-assisted secondary non-vascularized iliac crest bone grafts following advanced oral cancer resection with reconstruction plates ± adjuvant chemoradiotherapy or radiotherapy were examined at least 1 year after the mandibular reconstructions. Patient records, as well as radiological and surgical data, were analyzed. Average cancer follow-up time was 18.0 months, and patients that underwent secondary functional and esthetic reconstruction had an average mandibular defect length of 65.5 mm. Complete bone healing was observed in all patients. However, four patients experienced wound dehiscence and surgical site infection, which required local management for complete wound healing. Adjuvant radiotherapy played a signifi cant role (p < 0.05) in reconstruction site morbidity. In addition, eight patients (72.7%) received subsequent dental implants for oral functional rehabilitation. Our results suggest that non-vascularized iliac crest bone grafts are a reliable treatment option for secondary reconstruction of mandibular continuity defects up to a moderate length in oral cancer patients. However, radiotherapy may confound postoperative complications. Limitations of this technique include that the mandibular defect may be lateral and an extraoral approach is required.

Application of a Real-Time Three-Dimensional Navigation System to Dental Implant Removal: A Five-Year Single-Institution Experience

“…Computer-assisted surgery is performed for the treatment of various diseases and maxillofacial lesions such as oral cancer, temporomandibular ankylosis, and trauma 5,6,7) . Computer assistance before and during the surgery can facilitate more precise and safer surgery 5,6,7) . In particular, computer analysis and assistance are indispensable for dental implant insertion surgery.…”

Analysis of Quality of Life With 3D-Printed Model vis-á-vis Conventional Procedure in Oral & Maxillofacial Surgery – An Empirical Study

“…The literature shows successful use of both vascularized and non-vascularized bone grafts for reconstruction of defects and deformities of midface and mandible with the ultimate aim of providing adequate bone for dental rehabilitation, more recently by insertion of osseointegrated dental implants. 1,2 It is difficult to replicate the complex three-dimensional conformation of the face. Any deviation from structural alignment may likely lead to functional disturbances like malocclusion and temporomandibular joint disorders.…”

“…The literature shows successful use of both vascularized and non-vascularized bone grafts for reconstruction of defects and deformities of midface and mandible with the ultimate aim of providing adequate bone for dental rehabilitation, more recently by insertion of osseointegrated dental implants. 1,2…”