Immediate Reconstruction of Segmental Mandibular Defects With Nonvascular Bone Grafts: A 30-Year Perspective

Immediate Mandibular Reconstruction Using a Cellular Bone Allograft Following Tumor Resection in a Pediatric Patient

“…By providing all 3 essential bone remodeling properties, VF-CBA facilitated fusion at the defect site. Although VF-CBA has been used successfully to achieve fusion in spine and orthopedic applications, [13][14][15][16][17][18] its use in oral and maxillofacial surgery is an emerging application, [19][20][21] and in particular, to our knowledge, has not yet been shown in a pediatric patient. Therefore, this is the first known report of a successful immediate reconstruction of a large segmental mandibular defect using VF-CBA in a young child.…”

“…While not readily generalizable, the results from this case support the continued research for VF-CBA use in oral and maxillofacial surgery, consistent with previously published results. [19][20][21]…”

“…26 An increasing body of evidence is challenging this 6-cm rule, showing success of non-vascularized bone grafts used in reconstruction of larger segmental mandibular defects. 21,[26][27][28][29][30][31] A recent meta-analysis found no relationship between non-vascularized grafts and compartment or size of the defect. 30 Schlieve et al 29 demonstrated that, of 9 cases with segmental defects greater than 6.8 cm following resection for benign disease, all were successfully reconstructed using a non-vascularized graft.…”

“…A number of reports have demonstrated successful immediate mandibular reconstruction in cases of benign disease, including the present case, as well as in cases of acute or chronic infection. 21,27,29,32,33 In one of the earliest and most cited evaluations of simultaneous resection and reconstruction, Obwegeser 33 demonstrated success in intraoral approach for immediate mandibular reconstruction in patients with both benign disease and gross infection. He emphasized that absolute immobilization coupled with wellapproximated, tension-free soft-tissue closure, and with antibiotic treatment, as applicable, are essential for success.…”

Use of the Cover-Lifting Technique in Mandibular Cemento-Ossifying Fibroma Excision to Preserve the Inferior Alveolar Nerve

“…In the patient, the distance from the deepest part of the neoplasm to the inferior border of the mandible was less than 1 cm; thus, we performed segmental resection. According to the "6 cm rule" described by Marschall et al [8], mandibular defects larger than 6 cm should be reconstructed with vascularized grafts, whereas nonvascular bone grafts should be used for smaller defects. The patient's tumor was approximately 3 × 3 × 2.5 cm, and so, we chose a nonvascular iliac bone graft for reconstruction.…”