34 Mandibular Reconstruction with Free, Nonvascularized Bone Grafts The first free transplantations of autologous bone for reconstruction of the mandible were performed by Lexer, who, in 1907, used bone from the tibia and, in 1908, part of a rib (Reichenbach and Schöneberger, 1957). Various techniques of reconstruction have since been developed. The functional integration of a free bone transplant into the local bone structures is of the greatest importance to a successful outcome. This ensures that physiological stress factors can influence early remodeling of the transplanted bone. The quality of the bone transplant, the stability of bone fixation, and the condition of the surrounding soft tissue are critical to the success of the transplantation. Experience has shown that the iliac crest is the ideal bone for reconstruction of the jaw. Rib transplants are mainly used as substitutes for the neck and head of the condyle and for reconstruction of children’s jaws. Reconstruction is usually performed using an extraoral approach. In cases of benign tumors a primary reconstruction directly following resection is possible. This can be done intraorally, if the size and location of the tumor allow it. In malignant tumors bone reconstruction is generally performed as a secondary operation after 1 year free from recurrence. Wire was the most frequently used osteosynthesis material for the fixation of an iliac crest transplant until 1975. Even today, parallel or crossed double-wiring with 0.5 mm soft steel wire is a reliable method of simple fixation, but it requires intermaxillary fixation for approximately 8 weeks because of its limited stability (Fig. 34.1). Intermaxillary immobilization is unnecessary if bridging plates are used. This type of plate (e. g., AO, Osteo, Synthes, etc.) has to be fixed to the stumps of the mandible with at least three screws (Fig. 34.2
Introduction
Technique
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