Pathologic mandibular fracture after biting crab shells following ramal bone graft

Area of Science:

• Oral and Maxillofacial Surgery
• Reconstructive Surgery

Background:

• The mandibular ramus is a common source for bone grafts in maxillofacial reconstruction due to ample bone stock and minimal donor site morbidity.
• Despite its advantages, harvesting bone from the mandibular ramus carries a rare risk of inducing a pathologic mandibular fracture.

Observation:

• A 59-year-old male developed a pathologic mandible fracture after a sinus bone graft using ramal bone.
• The fracture occurred 2 weeks post-procedure, reportedly due to biting hard food (crab shells).

Findings:

• The patient was treated with closed reduction and intermaxillary fixation for 4 weeks.
• At 3 months post-treatment, the patient achieved stable occlusion, normal mouth opening, and preserved sensation.

Implications:

• Surgical technique during ramal bone harvesting should avoid overly vertical osteotomies to minimize fracture risk.
• Strict postoperative instructions advising patients to avoid hard foods for at least 4 weeks are crucial for preventing this complication.