Non-vascularised iliac crest bone graft for immediate reconstruction of lateral mandibular defect

Mandibular defect reconstruction is extremely important to achieving an improved quality of life of patients as this bony defect influences facial harmony and aesthetics. Reconstruction of mandibular defects at our centre comprises use of reconstruction plate, non-vascularised anterior iliac crest graft and vascularised fibula flap. Despite the large mandibular defect recorded in our developing environment, non-vascularised iliac crest graft continues to play a role in its exclusive use for lateral mandibular defects. The aim of this study was to analyse the role, complications and outcomes of the use of non-vascularised iliac crest graft for mandibular reconstruction in a free flap-enabled centre.

This was a retrospective case cohort from study institution’s records of mandibular reconstruction following mandibular surgery for benign tumours. Eligibility for study inclusion comprised case cohort with head and neck diseases requiring mandibular surgery and reconstruction with either reconstruction plate, non-vascularised iliac crest graft or vascularised fibula flap.

A total of 18 subjects underwent iliac crest grafting. Of the 18 subjects with iliac crest graft, 7 (39 %) were females while 11 (61 %) were males. Ten of the 18 subjects with iliac crest grafting were diagnosed with ameloblastomas. Six (33.3 %) subjects had class H (Jewer’s classification) mandibular defect. The average graft length was 5.4 cm and height was 2.3 cm. Three cases experienced graft site complications of which two grafts were lost. All 18 cases experienced good to acceptable clinical outcomes. Predictors of graft outcome were not statistically significant.

Despite our small sample size, it is suggestible that non-vascularised iliac crest graft be considered for lateral mandibular defect reconstruction, considering the reduced graft failure rate and satisfactory clinical outcomes from this study.