Mandibular Reconstruction with Lateral Tibial Bone Graft: An Excellent Option for Oral and Maxillofacial Surgery

Abstract

Autogenous bone grafts are the gold standard for reconstruction of atrophic jaws, pseudoarthroses, alveolar clefts, orthognathic surgery, mandibular discontinuity, and augmentation of sinus maxillary. Bone graft can be harvested from iliac bone, calvarium, tibial bone, rib, and intraoral bone. Proximal tibia is a common donor site with few reported problems compared with other sites. The aim of this study was to evaluate the use of proximal tibia as a donor area for maxillofacial reconstructions, focusing on quantifying the volume of cancellous graft harvested by a lateral approach and to assess the complications of this technique. In a retrospective study, we collected data from 31 patients, 18 women and 13 men (mean age: 36 years, range: 19-64), who were referred to the Department of Oral and Maxillofacial Surgery at the Servidores do Estado Federal Hospital. Patients were treated for sequelae of orthognathic surgery, jaw fracture, nonunion, malunion, pathology, and augmentation of bone volume to oral implant. The technique of choice was lateral access of proximal tibia metaphysis for graft removal from Gerdy tubercle under general anesthesia. The mean volume of bone harvested was 13.0 ± 3.7 mL (ranged: 8-23 mL). Only five patients (16%) had minor complications, which included superficial infection, pain, suture dehiscence, and unwanted scar. However, none of these complications decreases the result and resolved completely. We conclude that proximal tibia metaphysis for harvesting cancellous bone graft provides sufficient volume for procedures in oral and maxillofacial surgery with minimal postoperative morbidity.

Cancellous Tibial Bone Graft for Malunion after Mandibular Reconstruction in Head and Neck Cancer

“…Overall, 72% of the TBGs achieved successful bony union. Previous studies have reported success rates between 69% and 99% after orthognathic surgery or trauma‐related nonunion 12,27,33 . Our high success rates are reassuring given that our cohort had higher rates of radiation‐induced nonunion: 5%–11% previously reported compared to 67% of our patients underwent radiation after initial therapy 27,33 .…”

“…12,27,33 Our high success rates are reassuring given that our cohort had higher rates of radiationinduced nonunion: 5%-11% previously reported compared to 67% of our patients underwent radiation after initial therapy. 27,33 The only association with successful union was increased age. However, our small numbers would caution against any meaningful interpretation of this result.…”

“…Several studies have examined contributing factors to development of nonunion including adjuvant chemotherapy and radiation, 9,18‐21 type of plate used, 14,22‐25 and features of the bone removed (i.e., shape, size, osteotomy location, osteotomy orientation) 4,17,25 . Several reports examining management of nonunion after mandibular fractures or orthognathic surgery discuss antibiotic therapy, mandibular debridement, revision osteotomies and plating, immobilization, bone grafting, and vascularized flaps in their treatment algorithms 26‐29 . However, there is limited data on management options suggested for nonunion after head and neck cancer reconstruction 30 …”

Commonly Utilized Non Vascularised Bone Grafts in Maxillofacial Reconstruction

“…Apart from the common post-operative surgical complications like infection, wound dehiscence, pain, gait disturbance, and paraesthesia, proximal tibia fractures have seldomly been reported in the literature [2] [51]. In a retrospective study by Ana Lucia et al on 31 patients who underwent tibial bone harvesting, only 5 cases of minor complications were noted which all self-resolved within three weeks [52]. Kushner reported a complication rate of just 1.4% in a series of 141 patients [49].…”

Evaluation of the Proximal Tibia as a Donor Site of Cancellous Bone for Intraoral Grafting Procedures—A Retrospective Study

“…It is also noted that the anatomy of the proximal tibia practically excludes the possibility of intra-operative complications. There is little information available about serious complications of the surgical procedure [ 26 , 27 , 28 , 29 , 30 , 31 ].…”