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Ogundipe et al. Iliac-bone graft reconstruction for benign mandibular pathology

INTRODUCTION (VBG) overcomes these shortcomings by virtue of its
inherent own vascularity and can also be harvested
Mandibular defects resulting from tumor ablation with soft tissue for cover and lining in situations where
often result in considerable challenges to the patient there is defective soft tissue at the recipient site. This
and the surgeon. [1,2] On the part of the patient there explains the increased popularity of vascularized bone
is varying degree of functional, aesthetic and psycho- graft which is fast becoming the standard of care in
social challenges which may severely affect the quality reconstruction of mandibular continuity defect among
of life of the patient. On the part of the surgeon the many surgeons in developed nations. However it also
challenge is that of reconstruction to restore the normal has a number of disadvantages like longer length of
anatomic form and function of the mandible. [3,4] Various surgery, expensive equipment and expertise. [2,13-15]
reconstructive options that have been documented in
published literature include autograft, xenograft and NVBG still remains an attractive and viable option in
alloplast. [4-6] Newer options like genetically engineered mandibular reconstruction in many parts of the world
bone and distraction osteogenesis are also getting especially in developing countries where there is no
more attention among surgeons as novel options for facility or expertise for microvascular anastomosis.
mandibular reconstruction. [7-10] This traditional technique for the reconstruction of
the mandible is indicated mainly to bridge segmental
Use of alloplast as bridging plates may have the defects of the mandible where adjuvant radiotherapy
advantage of ease of placement, maintenance is not indicated after ablative surgery. [16] Possible
of shape over time, lack of donor site morbidity, donor sites for NVBG include the calvarium, ilium,
satisfactory aesthetic outcome in the immediate post rib, scapula, clavicle and fibula. [3,17] However the
operative period but the draw back is in the long term ilium remains the workhorse with most authors due
performance due to the risk of hardware rejection, to its relative advantages like ease of harvest, good
fracture, plate extrusion and limitation in use of dental osseous bulk, contour, favorable bio-mechanics and
implants. A failure rate of 60-80% for alloplastic material sufficient width for implant placement. [17,18] Despite its
has been documented in the literature. [3] relative advantages, varied complication/failure rate
have been reported with non-vascularized iliac crest
Newer options like genetically engineered bone are still bone graft (NVICBG) while controversies remain
in the early stage of development, needs expensive about the ideal timing for the reconstruction. [3,18,19]
equipment, expertise and are not widely available yet. Immediate reconstruction is highly desirable and could
[9]
potentially eliminate the shortcomings of delayed
At present, autogenous graft (vascularized or non procedure such as functional and aesthetic limitation
vascularized) remains the most popular means of leading to reduced quality of life. Furthermore, the high
reconstructing continuity mandibular defect having the failure rate previously cited [20,21] with immediate NVICBG
best chance of take as they provide viable and immune has been countered by other authors who opined that
compatible osteogenic cells. [11,12] failure may be connected with inappropriate patient
selection and sub-optimal method of treatment. [22,23]
The main aim of mandibular reconstruction following The aim of this review was to conduct a systematic
ablative surgery is the restoration of form and function literature review on the complication and failure rates
usually achieved by autogenous bone grafts (ABG). [13,14] of use of NVICBG and factors associated with failure.
Different sites of the body are available for harvesting
the graft, however, the choice of a particular donor METHODS
site depends on factors such as the type and extent of
tissue defect, rehabilitation expectation of the patient, Literature search
condition of the recipient bed, availability of necessary We searched the PubMed, Medline and Cochrane
equipment and expertise of the surgeon. [2,13-15] ABG databases using the terms “mandibular reconstruction”
options include vascularized and non vascularized AND “autogenous bone graft” to retrieve all relevant
grafts. The major limitation of non-vascularized articles. The search was restricted to human studies
bone graft (NVBG) lies in the fact that it is avascular published in English. In addition, the ‘‘related articles’’
making it susceptible to infection thereby increasing options in PubMed Medline and manual search of
the chances of failure with increasing length of the bibliographies of identified articles were used to
defect. Also defective intra-oral soft tissue cover for retrieve additional studies.
the graft following tumor ablation exposes the NVBG
to the risk of failure from saliva microbial contamination Criteria for eligibility
and subsequent infection. Vascularized bone graft Studies were included if they reported on success/

138 Plastic and Aesthetic Research ¦ Volume 4 ¦ August 29, 2017