A combined approach of bifocal distraction and autogenous iliac grafting for reconstructing large mandibular defect: a unique approach to reconstruction

摘要

Aim: To reconstruct a mandibular continuity defect using a technique of bifocal distraction osteogenesis, causing minimal morbidity to the patient. Materials and methods: A forty five year old male with an incompletely reconstructed mandibular defect extending from the right subcodylar region to the symphysis region of the mandible for whom reconstruction of the defect was attempted using a custom made distractor device. The device was not able to achieve the planned target site of reconstruction. The device was removed and the remaining defect site was reconstructed autogenous anterior iliac block graft. Results: A significant portion of the large mandibular segmental defect was reconstructed using the bifocal distraction technique, with the residual defect being reconstructed using an anterior iliac block graft, hence avoiding a microvascular reconstructive procedure. Discussion: The procedure was planned to completely avoid a bone grafting or a microvascular procedure to reconstruct the lost mandible. However, complete regeneration was unable to be achieved due to various factors. A microvascular reconstruction was not attempted due to various known complications involving prolonged surgical procedure, donor site morbidity, failure of the uptake of graft, long term rehabilitation problem, and difficulty of dental rehabilitation. Conclusion: The patient obtained a satisfactory facial symmetry and a functionally continuous mandibular bone for daily function of speech, and once the dental rehabilitation is accomplished the chewing and swallowing functions, which were a tedious process for the patient before the procedure, would be re-established.