Mandibular reconstruction remains one of the most challenging problems for the head and neck surgeon. Various methods of mandibular reconstruction have been described, including free bone grafts, osteomyocutaneous flaps, free vascularized bone grafts, reimplantation of treated mandibles, and reconstruction using alloplastic materials with particulate cancellous bone and marrow grafts.
This paper describes the author's experience using a Dacron-urethane mandibular mesh tray filled with particulate cancellous bone and marrow for mandibular reconstruction.
Six patients underwent resection of the mandible for malignant tumors, 7 for benign tumors, and 1 for radiation osteomyelitis.
Immediate reconstruction was performed in 7 patients, and 5 of the 7 were successful. Delayed reconstruction was performed in another 7 patients, and 5 of the 7 were successful. The overall success rate was 71%. Mandibular reconstruction was successfully accomplished even following radiotherapy in 4 of 6 patients. The majority of the failures occurred in the first 10 days following surgery and the major factor in failure seemed to be related to intraoperative wound infection.
The Dacron-urethane mandibular mesh tray has the advantage of being malleable but stiff, and can be easily cut with scissors to fit the defect. The tray is radiolucent, faciliting follow-up examinations by routine roentgenograms and radionuclide scans. It can be used either before or after radiotherapy.
This reconstructive procedure is not technically difficult and does not require expertise in microvascular surgery. In selected patients, this procedure may significantly contribute to cosmetic and functional improvement following radical surgery of the mandible.