Immediate Reconstruction of Segmental Mandibular Defects with Non-Vascularized Bone Grafts

Purpose There is long-standing evidence that a segmental mandibular defect greater than 6cm needs to be reconstructed with a vascularized graft, which significantly increases patient morbidity. We challenge this notion. In this study, we determined maximum defect size that can be predictably reconstructed with nonvascularized bone grafts immediately after resection. Methods A retrospective chart review of 34 patients that had mandibular resections for benign pathologies that were immediately reconstructed with particulate marrow grafts were reviewed. The same senior surgeon at a university medical center oversaw all cases. Cohort demographic and descriptive data were obtained, resection size was determined, and statistics were calculated. Results The patient cohort had a mean age of 49 years (standard deviation [SD] = 12.2), and consisted of 16 males and 18 females. Mean follow-up time was 18 months. Diagnoses included 15 (44%) cases of osteomyelitis, 13 (38%) ameloblastomas, 5 (15%) ossifying fibromas, and 1 (3%) histiocytoma. Average resection size of all cases was 8.7 cm (SD = 4.1). Average resection size of successful grafts was 8.1 cm (SD = 3.2). Graft failures measured 12.1 cm (SD = 2.8). When comparing graft success versus failure there is statistical significance ( P t test. Thirty of 34 (88%) patients went on to achieve mandibular bony union after 1 surgery. Conclusions Taken together, these data demonstrate that segmental mandibular resections for benign pathology can be predictably reconstructed using non-vascular grafts up to 8.1Â ± 3.1cm. The morbidity and time of surgery of particulate marrow grafts is significantly less compared with free-flap reconstruction. Furthermore, the course of treatment in these patients is significantly decreased. This facilitates expedited convalescent care and an earlier return to normal form and function.