Computer-assisted Secondary Reconstruction of Mandibular Continuity Defects Using Non-Vascularized Iliac Crest Bone Graft Following Oral Cancer Resection

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  • Kanno Takahiro
    Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
  • Karino Masaaki
    Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
  • Yoshino Aya
    Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
  • Koike Takashi
    Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine Division of Oral and Maxillofacial Surgery, Hamada Medical Center
  • Tatsumi Hiroto
    Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine Division of Oral and Maxillofacial Surgery, Oki Regional Hospital
  • Tsunematsu Koji
    Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine Division of Oral and Maxillofacial Surgery, Masuda Red Cross Hospital
  • Nariai Yoshiki
    Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine Division of Oral and Maxillofacial Surgery, Matsue City Hospital
  • Ide Taichi
    Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
  • Bai Yunpeng
    Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
  • Dong Quang Ngoc
    Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
  • Sekine Joji
    Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine

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<p>The surgical treatment of oral cancers can lead to continuity defects of the mandible. However, microvascularized free-tissue transfer has several limitations, including issues with morbidity of the donor site, complications and a poorly fitted bone geometry. Thus, non-vascularized iliac crest bone grafting, an established conventional technique, remains a feasible alternative for the reconstruction of mandibular continuity defects following advanced oral cancer resection. The purpose of this study was to retrospectively evaluate treatment outcomes using computer-assisted secondary reconstruction of mandibular continuity defects through non-vascularized iliac crest block grafts over a 5-year period and to explore clinical limitations. A total of 11 consecutive advanced oral cancer patients (6 males and 5 females; mean age, 66.6 years) were included in this study. Participants that received computer-assisted secondary non-vascularized iliac crest bone grafts following advanced oral cancer resection with reconstruction plates ± adjuvant chemoradiotherapy or radiotherapy were examined at least 1 year after the mandibular reconstructions. Patient records, as well as radiological and surgical data, were analyzed. Average cancer follow-up time was 18.0 months, and patients that underwent secondary functional and esthetic reconstruction had an average mandibular defect length of 65.5 mm. Complete bone healing was observed in all patients. However, four patients experienced wound dehiscence and surgical site infection, which required local management for complete wound healing. Adjuvant radiotherapy played a significant role (p < 0.05) in reconstruction site morbidity. In addition, eight patients (72.7%) received subsequent dental implants for oral functional rehabilitation. Our results suggest that non-vascularized iliac crest bone grafts are a reliable treatment option for secondary reconstruction of mandibular continuity defects up to a moderate length in oral cancer patients. However, radiotherapy may confound postoperative complications. Limitations of this technique include that the mandibular defect may be lateral and an extraoral approach is required.</p>

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