Reconstruction of Continuity Defects of the Mandible with Non-vascularized Bone Grafts. Systematic Literature Review

Abstract

Background The use of NVBG for mandibular defects seems to be gradually giving way for more advanced reconstructive techniques but it has the advantages of shorter operating time and lesser amount of blood loss. The aim of this study was to review the available data on the success and failure rates of use of NVBG and factors associated with failure. Method Studies published from 1978 to 2014 regarding the use of NVBG were searched. Most important information was graft success and failure outcomes. Information on graft success with particular focus on large defects was extracted and the quality of papers was rated. Defects > 6cm were considered long defects. Results Twenty publications were included in this review. The quality of the studies was low and there was high heterogeneity. All articles reported high graft success rates ranging from 67 to 100%. Success in defects > 6cm was considerable, the range was 72–100%. Three main factors were associated with failure; these were defect length, fixation method and infection. Infection contributed the highest complication rate which was 48.2%. Conclusion NVBG seems to be appropriate for mandible reconstruction when there is vascular recipient bed and sufficient soft tissue cover and mucosal lining are achievable.

Nonvascularized Bone Graft Reconstruction of the Irradiated Murine Mandible: An Analogue of Clinical Head and Neck Cancer Treatment

“…This has led to the relegation of NBGs to non-irradiated patients due to high failure rates secondary to vascular depletion and loss of cellular function in irradiated tissue beds. [32][33][34][35] In the clinical setting, radiotherapy has effectively pushed vascularized free tissue transfer to become the gold standard, but this technique now has shortcomings due to a lack of secondary reconstructive options beyond repeat free flap procedures. Furthermore, vascularized free tissue transfer has inherent disadvantages of prolonged operations, increased donor site morbidity, and the requirement of specialized training and operative equipment.…”

“…Furthermore, vascularized free tissue transfer has inherent disadvantages of prolonged operations, increased donor site morbidity, and the requirement of specialized training and operative equipment. 5,34,[36][37][38] Despite this, little investigation has focused on the potential reengineering of bone healing that would allow the reintroduction of NBGs to afford irradiated patients their inherent advantages. 2 Such efforts to would require an animal model that reflects the clinical reconstruction of head and neck cancer patients.…”

Secondary Management of Mandible Fractures

“…2 In these situations, nonvascular bone grafts (NVBGs) can be used to bridge the gap between segments. NVBGs can be harvested from the ilium, rib, fibula, calvarium, or even the ramus, 11 and they carry the advantages of shorter operating times, less blood loss, and lower costs than vascular bone grafts (VBGs).…”

“…12 Akinbami systematically reviewed six studies evaluating the success of bone grafts in mandible fractures and identified multiple factors linked to the failure of NVBG, the most prominent of which were use of a nonrigid fixation method (such as trans-osseous wires), infection, and defects > 6 cm in length. 11 Overall, success rate in defects > 6 cm were still considerably high (72-100%) in the presence of favorable conditions such as good vascularity and inherent regenerative capacity, but the review suggested that despite high success rates with favorable conditions, NVBGs should still be avoided when there are gross soft tissue deficits.…”

Tissue engineering in mandibular reconstruction: osteogenesis-inducing scaffolds

“…A mandibular defect is the loss of a lower jaw bone segment that produces a gap within the bone of 2 cm or more, resulting in a continuity or non-continuity mandibular defect [1] . These defects primarily arise from tumor resection, infection, physical trauma, and osteomyelitis [2] .…”