Long-term evaluation after mandibular reconstruction with fibular grafts versus microsurgical fibular flaps

This retrospective study was performed to compare the bone resorption rates of revascularized free fibular flaps with those of avascular fibular bone grafts. Special attention was drawn to horizontal bone resorption.

One hundred twelve patients who had received fibular grafts for reconstruction of the mandible were included in this study. Surgery was performed between 1991 and 2004, leading to a follow-up of 12 to 140 months. In 7 cases, microvascular onlay grafts (group A), and in 61 cases, microvascular reconstruction of segmental defects (group B) were performed. Avascular onlay grafts were applied (group C) in 41 patients and avascular reconstruction of segmental defects (group D) was performed in 7 patients. Bone heights were measured on panoramic views at 1, 3, and 7 years postoperatively.

Most of the resorption in group B occurred during the first postoperative year, at an average rate of 16% (range, 3% to 30%). After the first year, transplants became almost stable, and an average of 80% of bone height was maintained after 7 years. Conversely, bone resorption continued regularly in group C, and up to an average of 51% (range, 5% to 80%) of bone height was lost after 7 years postoperatively.

After mandibular reconstruction with fibular transplants, resorption occurs among both microsurgical and free grafts; however, the bone resorption rate was higher among avascular grafts. In group A and B patients, fibular grafts became stable after 1 year, but bone resorption continued at a regular rate in groups C and D.