Variation in the Repair of a Rib Graft used for Mandibular Reconstruction after 20 years

Mandibular reconstruction has been used in the last 100 years as a safe, effective and stable technique. Various types of grafts have been used, including the autogenous rib graft; the normal repair of this type of graft has been defined in some studies although some observations have been made indicating low predictability of the growth of this bone. The aim of this study was to report the case of a patient with a rib graft for mandibular reconstruction where after 20 years cartilaginous tissue was observed exclusively in the absence of bone tissue. A 61-year-old female patient presented in the Oral and Maxillofacial Surgery Service for dental implants. The patient had a history of 4 previous mandibular reconstructions; imaging showed no alterations to the normal evolution of a graft. However, the intraoral access contained softer tissue than the normal bone, and thus the implant installation was abandoned. Histopathological analysis revealed the formation of collagenous tissue and cartilage, chondrocytes island conditions characteristic of cartilaginous tissue in the absence of mineralization and cancellous bone. This led to the conclusion that repair conditions can vary based on specific and general factors as yet under discussion.(AU) La reconstruccion mandibular ha sido utilizada en los ultimos 100 anos como una tecnica segura, eficaz y estable. Diversos tipos de injertos se han utilizado siendo el auto trasplante de hueso costal uno de ellos; la normal reparacion de este tipo de injertos ha sido definida en algunas investigaciones aunque se han realizado otras observaciones indicando baja predictibilidad del crecimiento de este hueso; el objetivo de esta investigacion es reportar un caso de una paciente portadora de injerto costal para reconstruccion de mandibula donde despues de 20 anos se observo exclusivamente tejido cartilaginoso en ausencia de tejido oseo. Una paciente del sexo femenino, 61 anos se presento al Servicio de Cirugia Oral y Maxilofacial para ser tratada con implantes dentales; la paciente presentaba historia de 4 reconstrucciones mandibulares previas; los estudios de imagen se presentaban sin alteraciones a la condicion normal de la evolucion. Sin embargo, al acceso intraoral se observo un tejido mas blando que el hueso normal, abortandose la instalacion del implante. El analisis histopatologico revelo la formacion de tejido colageno y cartilago, condrocitos en lagunas y condiciones caracteristicas de tejido cartilaginoso en ausencia de mineralizacion y trabeculado oseo.Se concluye que las condiciones de reparacion pueden variar en base a factores especificos y generales aun en discusion.(AU)