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A two-year audit of non-vascularized iliac crest bone graft for mandibular reconstruction: technique, experience and challenges.

Omeje K, Efunkoya A, Amole I, Akhiwu B, Osunde D - J Korean Assoc Oral Maxillofac Surg (2014)

Bottom Line: Jaw tumors seen were ameloblastoma (n=15; 83.3%) and osteosarcoma (n=1; 5.6%).Treatments done were mandibular resection with condylar resection (n=7; 38.9%), mandibular segmental resection (n=10; 55.6%) and subtotal mandibulectomy (n=1; 5.6%).NVIBGs provide an acceptable alternative to vascularized bone grafts, genetically engineered bone, and distraction osteogenesis for mandibular reconstruction in resource-limited centers.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria.

ABSTRACT

Objectives: Non-vascularized iliac crest bone graft (NVIBG) is a known treatment option in mandibular reconstruction following jaw resection, but no documented review of patients treated with NVIBG exists for northern Nigeria. The experience and technique from a Nigerian tertiary hospital may serve as baseline data for comparison and improvement of practice for other institutions.

Materials and methods: A retrospective review of medical records and patient case files from January 2012 to December 2013 was undertaken. All case files and other medical records of patients who had reconstruction with NVIBG for benign or malignant lesions with immediate or delayed reconstruction were selected for review.

Results: Twenty patients had mandibular reconstruction with NVIBG during the study period. Two patients were excluded because of incomplete medical records. Eighteen patients' (male=14, female=4) records were reviewed. Their ages ranged from 13 to 62 years (mean 26.0±10.6 years). Indications for NVIBG included jaw tumors (n=16; 88.3%), jaw cyst (n=1; 5.6%) and gunshot injury (n=1; 5.6%). Jaw tumors seen were ameloblastoma (n=15; 83.3%) and osteosarcoma (n=1; 5.6%). Treatments done were mandibular resection with condylar resection (n=7; 38.9%), mandibular segmental resection (n=10; 55.6%) and subtotal mandibulectomy (n=1; 5.6%). Patients' postoperative reviews and radiographs revealed good facial profile and continued bone stability up to 1 year following NVIBG.

Conclusion: NVIBGs provide an acceptable alternative to vascularized bone grafts, genetically engineered bone, and distraction osteogenesis for mandibular reconstruction in resource-limited centers.

No MeSH data available.


Related in: MedlinePlus

The iliac crest exposed and vertical stops placed bilaterally at the required length.
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Figure 2: The iliac crest exposed and vertical stops placed bilaterally at the required length.

Mentions: Bone harvest was achieved using two vertical stop cuts placed on either end of the required length, using an osteotome combined with a traversing horizontal cut.(Figs. 1, 2) Several gentle knocks were used to complete the cuts to prevent visceral injuries. Medullary chips were routinely harvested from the iliac crest to augment the butts at the graftgraft intersection. Following harvest of the graft, bone-wax was cemented over the bone cut surfaces and the incision was closed with sutures. An improvised drain (two-way urethral catheter anchored to a urine bag) was used at the donor site for all patients and was removed 2 to 4 days postoperatively depending on the activity of the drain. Long acting local anesthesia (0.5% plain Marcaine) was routinely administered at the harvest site to reduce postoperative pain.


A two-year audit of non-vascularized iliac crest bone graft for mandibular reconstruction: technique, experience and challenges.

Omeje K, Efunkoya A, Amole I, Akhiwu B, Osunde D - J Korean Assoc Oral Maxillofac Surg (2014)

The iliac crest exposed and vertical stops placed bilaterally at the required length.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4279977&req=5

Figure 2: The iliac crest exposed and vertical stops placed bilaterally at the required length.
Mentions: Bone harvest was achieved using two vertical stop cuts placed on either end of the required length, using an osteotome combined with a traversing horizontal cut.(Figs. 1, 2) Several gentle knocks were used to complete the cuts to prevent visceral injuries. Medullary chips were routinely harvested from the iliac crest to augment the butts at the graftgraft intersection. Following harvest of the graft, bone-wax was cemented over the bone cut surfaces and the incision was closed with sutures. An improvised drain (two-way urethral catheter anchored to a urine bag) was used at the donor site for all patients and was removed 2 to 4 days postoperatively depending on the activity of the drain. Long acting local anesthesia (0.5% plain Marcaine) was routinely administered at the harvest site to reduce postoperative pain.

Bottom Line: Jaw tumors seen were ameloblastoma (n=15; 83.3%) and osteosarcoma (n=1; 5.6%).Treatments done were mandibular resection with condylar resection (n=7; 38.9%), mandibular segmental resection (n=10; 55.6%) and subtotal mandibulectomy (n=1; 5.6%).NVIBGs provide an acceptable alternative to vascularized bone grafts, genetically engineered bone, and distraction osteogenesis for mandibular reconstruction in resource-limited centers.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria.

ABSTRACT

Objectives: Non-vascularized iliac crest bone graft (NVIBG) is a known treatment option in mandibular reconstruction following jaw resection, but no documented review of patients treated with NVIBG exists for northern Nigeria. The experience and technique from a Nigerian tertiary hospital may serve as baseline data for comparison and improvement of practice for other institutions.

Materials and methods: A retrospective review of medical records and patient case files from January 2012 to December 2013 was undertaken. All case files and other medical records of patients who had reconstruction with NVIBG for benign or malignant lesions with immediate or delayed reconstruction were selected for review.

Results: Twenty patients had mandibular reconstruction with NVIBG during the study period. Two patients were excluded because of incomplete medical records. Eighteen patients' (male=14, female=4) records were reviewed. Their ages ranged from 13 to 62 years (mean 26.0±10.6 years). Indications for NVIBG included jaw tumors (n=16; 88.3%), jaw cyst (n=1; 5.6%) and gunshot injury (n=1; 5.6%). Jaw tumors seen were ameloblastoma (n=15; 83.3%) and osteosarcoma (n=1; 5.6%). Treatments done were mandibular resection with condylar resection (n=7; 38.9%), mandibular segmental resection (n=10; 55.6%) and subtotal mandibulectomy (n=1; 5.6%). Patients' postoperative reviews and radiographs revealed good facial profile and continued bone stability up to 1 year following NVIBG.

Conclusion: NVIBGs provide an acceptable alternative to vascularized bone grafts, genetically engineered bone, and distraction osteogenesis for mandibular reconstruction in resource-limited centers.

No MeSH data available.


Related in: MedlinePlus