Osseous Changes Over Time in Free Fibular Flap Reconstruction

Area of Science:

• Oral and Maxillofacial Surgery
• Regenerative Medicine
• Biomaterials Science

Background:

• Mandibular defects often require reconstruction, with free fibular flaps being a common choice.
• Understanding bone resorption patterns in grafted and native mandibular bone is crucial for long-term success.
• Comparing resorption rates between fibular grafts and dentulous/edentulous native bone informs surgical and restorative strategies.

Purpose of the Study:

• To evaluate and compare bone resorption in free fibular grafts versus native dentulous and edentulous mandibular bone.
• To document the resorption behavior of fibular grafts in the context of mandibular reconstruction.

Main Methods:

• A retrospective chart review of 18 patients undergoing fibula free flap reconstruction for head and neck cancer.
• Postoperative computed tomography (CT) scans were analyzed to measure bone height, width, and cortical thickness.
• Resorption rates were calculated over time for fibular grafts and corresponding native mandibular sites.

Main Results:

• Fibular grafts exhibited significantly lower rates of bone resorption (height, width, and cortical thickness) compared to both dentulous and edentulous native mandible.
• Edentulous native mandible showed the highest rates of bone atrophy, followed by dentulous native mandible, and then fibular grafts.
• Specific resorption rates per year were quantified for height, width, and superior/inferior cortical thickness for each group.

Conclusions:

• Free fibular flap reconstruction provides stable mandibular reconstruction with minimal bone resorption compared to native bone.
• Edentulous native mandible is more prone to resorption than dentulous native mandible, impacting long-term stability.
• Further research is needed to explore the influence of dental restoration on the overall osseous stability of fibular grafts.