Particulate cancellous marrow crib graft reconstruction of mandibular defects

Between 1969 and 1978 more than 1000 mandible fractures were treated by the otolaryngology services at the University of Minnesota and affiliated hospitals. Most were successfully treated but 17 patients had significant loss of mandibular bone resulting in a much more difficult management problem. The loss of bone was usually due either to the initial injury such as a gunshot wound or was secondary to the complications of non-union or osteomyelitis. Particulate cancellous marrow grafts within a Vitallium or titanium mesh crib (PCM crib graft) were used to reconstruct the mandibular defects. One patient had bilateral defects requiring 2 PCM crib grafts. Thus, 18 grafts spanning defects 2 to 12 cm were performed. Success was measured by a stable mandible with satisfactory occlusion and he ability to chew, swallow and articulate satisfactorally. Of 18 grafts, 15 met these requirements. Several factors important to successful mandibular reconstruction included adequate immobilization, intraoral soft tissue coverage, external skin cover and tension-free closure and optimal intraoral hygiene. The crib used to hold the particulate cancellous marrow in position during the healing phase has been removed in three otherwise successful cases because of intraoral mucosal tenting or dehiscence or to allow adequate fitting of dentures. In our experience, the use of autogenous cancellous bone and marrow in metallic mesh has been a successful means of restoring function and stability to mandibular defects.