Mandibular reconstruction. Current state of the art.

At the present time several techniques of bone grafting for restoration of mandibular defects are being employed. These methods are well established by clinical trials and animal research. Other methods are in the experimental stage. Regardless of the technique utilized it remains paramount that the surgeon plan the initial procedure with great care as each failure results in diminished blood supply to the graft bed and makes subsequent procedures less likely to succeed. The well known principles of bone grafting involve establishing good nutritional status of the patient, proper preparation of the graft bed by insuring adequate soft tissue and adequate blood supply, elimination of infection from the graft bed, provision of adequate fixation and immobilization of the graft, and careful closure of soft tissues to prevent hematoma formation. These principles remain inviolable if the procedure is to succeed.