STAGED MANDIBULAR RECONSTRUCTION WITH RECIPIENT BED SCULPTING BY SILICONE SPACER, AND PARTICULATE ILIAC CREST BONE GRAFT
Authors:
Carlo Ferretti
Affiliation:
Private Practice, Johannesburg, South Africa
Doi: 10.54936/haoms242p62
ABSTRACT:
The reconstruction of segmental defects of the mandible is routinely performed with vascularised grafts due to persistence of the idea that non-vascularised grafts have a 6cm length restriction . This presentation will present the outcomes for a staged protocol for particulate graft reconstruction of mandibular defects far in excess of 6cm.
Materials and methods: Patients with segmental defects of are reconstructed at ablative surgery with a patient matched plate and a silicone spacer. 8 weeks later the defect was exposed from an extraoral approach, the spacer was removed. A posterior iliac crest graft was harvested and morselised. The PCCB was maximally compressed and implanted in the defect site.
Results: Medical grade silicone spacer is easily and rapidly adaptable to any defect, supports unhindered wound healing, is easily removable at re-entry and, dehiscence is a rare complication. The use of a spacer expedites secondary reconstruction of mandibular defects and provides the basis for highly predictable PCCB graft reconstruction. Restitution of both alveolar height and arch morphology is readily achieved. Mean defect length in centimeters was 12.35 ± 8.4 (range 5-18)
Conclusion: Successful reconstruction of mandibular defects of any size is achievable with a compressed PCCB graft. Whilst no graft system is universally applicable, accepting the basic tenet that reconstruction should mean restitution to integrity, the PCCB graft achieves this goal more reliably (with lower morbidity) than other reconstruction options.
KEY WORDS:
Authors:
Carlo Ferretti
Affiliation:
Private Practice, Johannesburg, South Africa
Doi: 10.54936/haoms242p62
ABSTRACT:
The reconstruction of segmental defects of the mandible is routinely performed with vascularised grafts due to persistence of the idea that non-vascularised grafts have a 6cm length restriction . This presentation will present the outcomes for a staged protocol for particulate graft reconstruction of mandibular defects far in excess of 6cm.
Materials and methods: Patients with segmental defects of are reconstructed at ablative surgery with a patient matched plate and a silicone spacer. 8 weeks later the defect was exposed from an extraoral approach, the spacer was removed. A posterior iliac crest graft was harvested and morselised. The PCCB was maximally compressed and implanted in the defect site.
Results: Medical grade silicone spacer is easily and rapidly adaptable to any defect, supports unhindered wound healing, is easily removable at re-entry and, dehiscence is a rare complication. The use of a spacer expedites secondary reconstruction of mandibular defects and provides the basis for highly predictable PCCB graft reconstruction. Restitution of both alveolar height and arch morphology is readily achieved. Mean defect length in centimeters was 12.35 ± 8.4 (range 5-18)
Conclusion: Successful reconstruction of mandibular defects of any size is achievable with a compressed PCCB graft. Whilst no graft system is universally applicable, accepting the basic tenet that reconstruction should mean restitution to integrity, the PCCB graft achieves this goal more reliably (with lower morbidity) than other reconstruction options.
KEY WORDS: