Management of Mandibular Osteomyelitis with Segmental Resection, Nerve Preservation, and Immediate Reconstruction

Publication date: Available online 31 January 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Jeffrey S. Marschall, Robert L. Flint, George M. Kushner, Brian Alpert

Abstract

Purpose

To present our experience with management of mandibular osteomyelitis with segmental resection, nerve preservation and immediate reconstruction with non-vascularized bone grafts.

Patients and Methods

A retrospective analysis was completed of 18 cases overseen by a single practitioner at a university medical center from June 2011 to July 2018. All patients had osteomyelitis and were treated with segmental mandibular resection, inferior alveolar nerve (IAN) preservation, and immediate reconstruction with autogenous bone graft from the tibia. Data obtained from medical records included chief complaint at initial presentation, resection size, IAN neurosensory recovery at six months, as well as descriptive statistics of the patient cohort. The university institutional review board granted this study exempt status.

Results

The patient cohort had a mean age of 50.9 years, ranged from 29 to 70, and included 11 females and 7 males. Mean follow-up time was 15 months. The most common chief complaint at initial presentation was pathologic fracture (39%) followed closely by abscess (33%). Mandibular resection size of all patients was 8.1 cm (SD=3.3). Resection size with successful bone grafts (n=15) was 7.1cm (SD=2.6) and those that failed measured 13.1cm (n=3, SD=2.0; p=0.0016). IAN neurosensory testing demonstrated 54% of patients had no meaningful recovery at 6 months, 25% demonstrated partial recovery, and 21% demonstrated full recovery. Finally, osteomyelitis was eliminated in all patients.

Conclusion

Segmental mandibular resection is an effective method for eradicating mandibular osteomyelitis. Furthermore, immediate reconstructions via non-vascularized grafts were successful in cases with large defects, with a mean defect size of 7.1±2.6cm. However, IAN nerve sparing surgery is not effective for preserving patient IAN function. Taken together, we demonstrate that mandibular resection with immediate reconstruction is a viable method in the treatment of mandibular osteomyelitis. This method removes infection and shortens disease course.

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