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

No. of records identified through No. of additional records identified RESULTS
electronic database - 868 through other sources - 47
Initial elecronic searches of MEDLINE and Cochrane
No. of records after retrieved 868 articles as potentially eligible, 47
duplicate removed - 0 publications were identified from other sources. After
initial review of the titles and abstracts, 53 articles
No. of records screened - 915 were accepted for further consideration, and 862
were rejected [Figure 1]. Of the 53 articles accepted
No. of records excluded for further consideration, 46 were excluded because
- 862
they did not meet the inclusion criteria which left 7 full-
No. of full text articles assessed text articles for further consideration and analysis. Of
for eligibility - 53 the 7 included articles reviewed, all were retrospective
cohort studies except 2 which were prospective
No. of full text excluded longitudinal studies.
- 46
No. of full text include in A total of 127 patients treated with NVBG were included
qualitative analysis - 7 in this review. Gender characteristics were reported
in all the articles with slight female preponderance
(female 65/127, 51.2%; male 62/127, 48.8%). Age
No. of full text included in was reported as mean in all publications ranging 24.6-
quantitative meta analysis - 7
31.6 years. Table 1 shows the study characteristics
Figure 1: Flow chart of the publications. All the articles reviewed except
one reported the histologic diagnosis of the lesions
failure of immediate mandibular reconstruction of post for which mandibular resection was carried out.
ablative continuity defect of benign pathology using Majority of the lesions were ameloblastoma - 80
NVICBG. (74.8%), followed by ossifying fibroma - 9 (8.4%)
[Table 2]. Segmental mandibulectomy was done in
Articles that referred to infants or patients treated with 100 patients (78.7%) while the remaining 27 (21.3%)
radiation, had a diagnosis of malignancy, were being had hemi-mandibulectomy. Both intra and extra oral
grafted for reasons other than benign pathology and incisions were utilized in 100 patients (78.7%) with the
remaining 27 (21.3%) receiving only intra oral incision.
those that did not report a follow up of at least six Reconstruction plate was the method of fixation in
months were excluded. Reviews and case reports of the majority 87/127 (68.5%) while stainless steel
a single case were not included. The title and abstract wire/intermaxillary fixation was used in the remaining
of the identified articles were screened based on these 40/127 (31.5%). Autologous platelet rich plasma was
criteria after which the full text of all eligible articles used as graft enhancement in 32/127 patients. The
were retrieved for further analysis.
follow up period was presented as means, of which the
Extraction of data highest was 7 years and lowest was 6 months.
A proforma was used to extract data from the eligible Recipient site complications such as infection, wound
articles. Information extracted included primary author, dehiscence, etc. were reported in 16/120 [Table 3]
year of publication, study type, age and number of patients giving a complication rate of 13.3%. The case
patients, method of fixation, follow up, and documented series did not clearly report complication in the 7 cases
complication and failure. Extent of defect was classified presented however none of the cases failed as at last
as segmental and hemi-mandibulectomy defect. review. Overall failure rate was 4/127 or 3.1%. Of the
4 cases that failed, 2 were reported by 1 publication
For this review, recipient site complication was counted while 1 each was reported by other 2. All failures were
as per patient irrespective of the number. Failure is due to uncontrollable infection, 2 occurred in hemi-
defined as inability to control infection necessitating mandibulectomy defect while the remaining 2 occurred
graft loss or removal. Whenever possible, factors in segmental defect. One of the failed reconstruction
associated with failure were identified. had been enhanced with platelet rich plasma (PRP).
Age, gender, type of incision and method of fixation did
Statistical analysis not appear to affect failure rate.
Descriptive statistics was used for analysis. The
characteristics of the included publications were Only 22 patients (10 implants and 12 acrylic partial
summarized and presented in tables. dentures) received prosthesis following reconstruction.
Plastic and Aesthetic Research ¦ Volume 4 ¦ August 29, 2017 139