Long-term changes in bone height after mandibular reconstruction using a free fibula graft in an elderly population

Publication date: Available online 24 May 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Kosuke Ishikawa, Yuhei Yamamoto, Hiroshi Furukawa, Yoichi Ohiro, Akira Satoh, Toshihiko Hayashi
PurposeThis study evaluated short-term and long-term changes in bone height after mandibular reconstruction using an osteotomized fibula graft, with the aim of identifying factors associated with atrophy of the graft in an elderly population.MethodsThis retrospective study involved patients who underwent mandibular reconstruction using a free vascularized fibula graft between 2005 and 2015 and had at least 12 months of follow-up. Postoperative panoramic radiographs were used to measure bone height at standardized locations on each segment of the graft at 1 postoperative year and at late follow-up.ResultsThe sample was composed of 30 patients (15 men, 15 women; mean age, 62.6 years; age range, 50-80 years). According to the HCL classification, mandibular defect types were L (n = 19), LC (n = 7), LCL (n = 3), and H (n = 1). There were 0-3 segmental osteotomies with the fibula graft. None of the patients received an osseointegrated dental implant during a mean follow-up of 4.0 years (range, 1.5-9.7 years). All patients underwent reconstruction of the mandibular body, 10 of whom also underwent reconstruction of the mandibular ramus. Atrophy of the fibula graft was observed in 9.9% and 15.0% of the body segment and 5.9% and 6.6% of the ramal segment at 1 postoperative year and at late follow-up, respectively. Graft hypertrophy occurred in the ramal segment in 2 patients. Multivariate analysis revealed a significantly higher rate of graft atrophy in women than in men at late follow-up (P = .033).ConclusionsFibula grafts showed long-term stability, and in 2 cases even a gain in bone height, in this elderly population. Female sex was identified as a risk factor for atrophy of the fibula bone graft in the body segment of the reconstructed mandible.



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