Distraction osteogenesis in the irradiated canine mandible

The potential use of distraction osteogenesis in mandibular reconstruction has been limited by its questionable efficacy in previously radiated bone. We studied five mongrel dogs that had a hemimandible rendered edentulous and underwent a full course of external beam radiation therapy (50 Gy/20 fractions). Six months after completion of radiotherapy, a 2-cm critical-size segmental mandibular defect was created and stabilized with a stainless steel plate. A proximal mandibular transport segment was then formed and an external lengthening apparatus (Orthofix) applied. By means of bifocal distraction osteogenesis, the defects were filled with new bone in a period of 30 days in four of five dogs. Histologic analysis and fluorochrome microscopy confirmed the formation of new cortical bone. Our results suggest that distraction osteogenesis is successful in previously radiated bone and that it may be a simple method of mandibular reconstruction following ablative head and neck surgery.