Mandibular reconstruction in the young adult using free vascularized iliac crest

Five young adults between the ages of 16 and 27 years underwent mandibular reconstruction with free vascularized iliac crest bone grafts based on the deep circumflex iliac artery. These were the only patients under age 30 years in a series of over 60 patients undergoing this procedure. In all cases, the ipsilateral crest was employed, and special efforts were made to minimize bony bulk by removing the outer cortex and carefully shaping the graft. The bone graft underwent final trimming in situ, the exact dimensions being reproduced from measurements taken from the excised specimen. When bone alone requires replacement, as in the majority of young patients, an excellent functional result can be anticipated. Occlusion can be maintained or even restored, and the normal facial contour can be re-established. Osteointegrated implants hold out the possibility of providing full dental rehabilitation in an age group in which anything less is considered failure. Furthermore, the donor site scar can be hidden by a bathing suit. It is concluded that this form of reconstruction is particularly suitable for the young adult, in whom cosmesis, function, donor site, and freedom from long-term complications are of supreme importance.