Clinical Application Of Free Iliac Bone Flap In Mandibular Reconstruction

Objective:The purpose of this study was to evaluate the effectiveness of free iliac crest bone flap in the reconstruction of a mandibular segmental defect, its advantages as well as its disadvantages.Materials and Methods:Five patients were retrospectively reviewed in whom a free iliac bone flap was used to primarily reconstruct the segmental defect of mandible caused by tumor resection. A reconstructive titanium plate was preoperatively prefabricated at the help of a three-dimensional solid model of the jaws in two of the five patients. The patients were followed up regularly by means of return consultation, telephone consultation and questionnaire, so as to evaluate the appearance and function of the reconstructed mandible and of the donor site. In particular, Harris score was used for the evaluation of the rehabilitation of the donor site, and University of Washington quality of life questionnaire (UW-QOL) for that of the patients’ postoperative quality of life.Results:The mean time of operation was8hours and a half. The survival of the grafted free iliac bone flap was confirmed a week later in all patients by the increased uptake of radionuclide on technetium99m nuclear bone scanning. The shape of the mandible, as well as its height and width, were well restored in all patients. No obvious bone resorption was found in the follow-up. The profile of the lower face was symmetrical in two patients and slightly asymmetrical in the other three patients. Two patients were satisfied with their appearance and the other three considered it acceptable. The maximal interincisional mouth opening was over three centimeters in all patients. Their postoperative occlusion was similar to the preoperative one. The patients had a normal or soft diet and had no difficulty in swallowing. They all could speak clearly. No obvious donor site morbidity was observed in the last follow up. Harris score showed the excellent rehabilitation of the donor site in all patients. There was a high score in the UW-QOL questionnaire in all patients, indicating the quality of life was satisfactory. The questionnaire also showed that appearance, mastication and emotion were the three aspects mostly affected by the treatment. The operation period was shorter in the patients in whom rapid prototyping technique was applied and the reconstructive plate was prefabricated preoperatively. The appearance after treatment was also more symmetrical in these patients.Conclusions:1. The mandibular profile and maxillofacial functions can be well restored when a mandibular segmental defect is reconstructed with the transfer of free iliac bone flap.2. The large bone volume of the free iliac bone flap ensures an ideal height and width of the reconstructed mandible, and consequently provides sufficient bone quantity for the later implant prosthetic restoration.3. The harvest of the free iliac bone flap does little harm to the donor site function.4. The application of rapid prototyping technique in operation planning helps to shorten operation time and improve effect of reconstruction.