Reconstruction of Composite Mandible Defects Using a Cellular Bone Allograft and Soft Tissue Free Flap Coverage

Kevin J Carlson; Robert M Liebman; Matthew J Bak; William M Dougherty; Jonathan R Mark

doi:10.1177/19433875241237920

Reconstruction of Composite Mandible Defects Using a Cellular Bone Allograft and Soft Tissue Free Flap Coverage

Craniomaxillofac Trauma Reconstr. 2024 Mar 6:19433875241237920. doi: 10.1177/19433875241237920. Online ahead of print.

Authors

Kevin J Carlson^{1

2}, Robert M Liebman^{3

2}, Matthew J Bak², William M Dougherty², Jonathan R Mark²

Affiliations

¹ Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.
² Department of Otolaryngology - Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA.
³ Memorial Health University Medical Center, Savannah, GA, USA.

Abstract

Study design: Retrospective case series.

Objective: Cellular bone allografts (CBAs) contain the components of a successful bone graft with no autologous component and have been used extensively outside the head and neck. Descriptions of their utilization for mandible reconstruction are limited. We review our experience utilizing a CBA, with no autologous component, for the reconstruction of mandible defects.

Methods: Patients undergoing reconstruction of a composite mandible defect with a CBA, no added autologous component, within a patient-specific graft cage and soft tissue free flap coverage were retrospectively identified. Graft survival and defect management are assessed and results of post-operative imaging reported.

Results: Five subjects, aged 23-56 years, underwent reconstruction of mandible defects with the described technique. Defects resulted from gunshot wounds in 4 patients and the composite resection of a low-grade malignancy in one. The defect was definitively managed in 4 subjects, 3 of which had post-operative imaging demonstrating bone formation. The fifth experienced graft failure after developing an orocutaneous fistula and was successful salvaged with an osteocutaneous fibula free flap.

Conclusions: Our early experience is promising that a CBA, with no autologous component, and soft tissue free flap coverage can be used for the reconstruction of composite mandible defects in select patients.

Keywords: bone graft; cellular bone allograft; facial trauma; free flap; mandible reconstruction.