Mandibular reconstruction with non-vascularized bone graft in a double bridging technique

Reconstruction of the mandible following tumor resection or trauma can be challenging due to associated functional and esthetic problems. Various options have been described in the literature, but non-vascularized bone graft remain a viable option in middle- and low-income countries, Nigeria inclusive. We hereby report our experience with the use of non-vascularized bone graft with mandibular reconstruction plates in a double bridging technique for mandibular reconstruction in our institution.

Patients who had mandibular defect reconstruction with non-vascularized bone graft between January 2012 and December 2021 were included in this study. Grafts were harvested from either the rib or contralateral iliac crest and secured with mandibular reconstruction plate and screws in a double bridging technique. Patients were followed for a minimum of 12 months and outcomes such as the level of patients' satisfaction with appearance, graft take, bony continuity and complications were assessed and analyzed.

Twenty eight patients comprising 18 males and 10 females [M:F 1.8:1] had mandibular defect reconstruction with double bridging technique during the study period. Donor site distribution revealed that 64.3% [n=18] had their grafts harvested from the iliac crest while the remaining 10 [35.7%] were taken from the rib. Ameloblastoma [75%, n=21] was the commonest lesion necessitating resection of the mandible amongst the subjects. The follow up result showed that appearance was satisfactory in 25 patients [89%], graft take/ restoration of bony continuity in 27 patients [96%], graft infection occurred in 2 patients [7.1%] while only one case of graft failure was established [3.6%].

A combination of non-vascularized bone graft with reconstruction plate in a bridging technique is a viable option for mandibular reconstruction in a resource-limited setting.