Non-Vascularized Bone Grafts for Reconstruction of Segmental Mandibular Defects: Is length of graft a factor of success?
Andrei Marechek, DDS, MD∗,'Correspondence information about the author DDS, MD Andrei MarechekEmail the author DDS, MD Andrei Marechek
Resident, Department of Oral and Maxillofacial Surgery, Case Western Reserve University, Cleveland, OH
Ali Ahmad, BDS
Research Fellow, Department of Oral and Maxillofacial Surgery, Case Western Reserve University, Cleveland, OH
Sean Pack, DDS, MD
Private Practitioner, Former Resident at the Department of Oral and Maxillofacial Surgery, Case Western Reserve University, Cleveland, OH
Catherine Demko, PhD
Statistician, Case Western Reserve University School of Dentistry
Faisal Quereshy, MD, DDS, FACS
Program Director, Department of Oral and Maxillofacial Surgery, Case Western Reserve University, Cleveland, OH
Dale Baur, DDS, MD
Associate Professor and Chair, Department of Oral and Maxillofacial Surgery, Case Western Reserve University, Cleveland, OH
DOI: https://doi.org/10.1016/j.joms.2019.05.008
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Publication History
Published online: May 24, 2019
Accepted: May 6, 2019
Received in revised form: May 5, 2019
Received: March 10, 2019
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Abstract:
Purpose
The purpose of this study was to evaluate a long-debated question in the field of whether the success of reconstructing mandibular defects with non-vascularized bone grafts (NVBGs) is dependent on the length of the graft.

Materials and Methods
The inclusion criteria were patients who had received NVBGs, such as anterior/posterior iliac crest and costochondral grafts, to reconstruct segmental defects of the mandible between 2008 and 2017 at the Department of Oral and Maxillofacial Surgery at Case Western Reserve University. Patients with a history of irradiation to the head and neck and patients with inadequate follow-up were excluded from this study. Data such as defect length, patient age, comorbidities, length of follow up, location of defect, etiology of defect, and post-operative course were collected. Success was judged by radiographic and clinical evidence of bone continuity and stability at a minimum of 4 months post-operatively. Failures were considered as loss of all or part of the graft, resulting in a residual continuity defect requiring further bone grafting.

Results
Investigators identified 61 potential cases, of which 29 met the inclusion and exclusion criteria. Mean age of the patients at the time of grafting was 55 years (range: 17 to 81 years), with a mean follow-up length of 18 months. The length of defects ranged from 2cm to 22cm. Seven defects were ≤6cm in length and twenty-two defects were >6cm in length. All of the cases were grafted a minimum of 6 months after resection, and BMP was used in 25 (86%) of the cases. There was one failure in the ≤6cm group and two failures in the >6cm group, corresponding to success rates of 86% and 91%, respectively. Eight of the patients experienced minor complications such as wound dehiscence or infection which were resolved with local measures and antibiotics.

Conclusions
The results of our study show that NVBGs are a viable, safe, and effective treatment option for patients with segmental mandibular defects over 6cm in length in non-irradiated patients.