Mandibular reconstruction: Bone graft techniques

Results of treatment in a series of 60 patients undergoing mandibular reconstruction by a variety of methods are reported. Delayed reconstruction was performed, using a titanium mesh tray with cancellous bone fragments and block bone grafts removed from the iliac crest, rib, and mandible in 34 patients, with an overall success rate of 91%. Immediate reconstruction was performed with a wire mesh prosthesis containing particulate bone and composite flaps in 26 patients, with an overall success rate of 46%. Oral contamination of the graft at the time of surgery appeared to be the factor limiting the success of immediate mandibular reconstruction. Block grafts of bone were extremely reliable in reconstituting the continuity of the mandible when inserted through an extraoral approach as a delayed repair. Mandibular reconstruction was successfully accomplished even following high-dose radiotherapy.