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Management of Mandibular Osteomyelitis With Segmental Resection, Nerve Preservation, and Immediate Reconstruction
Jeffrey S Marschall1, Robert L Flint2, George M Kushner3
1Resident, Department of Oral and Maxillofacial Surgery, University of Louisville School of Dentistry, Louisville, KY.
Segmental mandibular resection effectively treats osteomyelitis, with immediate nonvascularized bone grafts succeeding in large defect reconstruction. However, inferior alveolar nerve (IAN) preservation during surgery did not consistently restore IAN function.
Area of Science:
- Oral and Maxillofacial Surgery
- Surgical Oncology
- Reconstructive Surgery
Background:
- Mandibular osteomyelitis presents significant challenges in treatment and reconstruction.
- Effective management requires addressing infection eradication and functional restoration.
Purpose of the Study:
- To evaluate the efficacy of segmental mandibular resection with nerve preservation and immediate nonvascularized bone grafting for treating mandibular osteomyelitis.
- To assess outcomes including infection control and inferior alveolar nerve (IAN) function recovery.
Main Methods:
- Retrospective analysis of 18 patients treated by a single practitioner.
- Segmental mandibular resection with inferior alveolar nerve (IAN) preservation and immediate tibial bone grafting.
- Data collection on presentation, resection size, and IAN neurosensory recovery at 6 months.
Main Results:
- Osteomyelitis was eradicated in all patients.
- Successful reconstruction was achieved in 15 out of 18 patients, with larger resections correlating with graft failure (p=0.0016).
- Significant IAN dysfunction persisted, with 54% showing no meaningful recovery at 6 months.
Conclusions:
- Segmental mandibular resection is effective for eradicating mandibular osteomyelitis.
- Immediate nonvascularized bone grafting is a viable option for large mandibular defects.
- IAN-sparing surgery in this context did not reliably preserve nerve function, suggesting a trade-off between infection control and nerve preservation.
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