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Iliac crest towards alveolar processes or mandibular inferior margin in mandibular reconstruction with a vascularized iliac bone flap: which is better?

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Abstract

Objective

The study aims to compare differences among iliac bone flaps with different iliac crest orientations for the repair of mandibular defects with an aim to analyze their advantages, disadvantages, and effects.

Material and methods

Clinical data and computed tomography scans of all patients who underwent iliac bone flap repair of the mandible in Peking University School and Hospital of Stomatology from January 2016 to April 2021 were collected. Patients were divided into the iliac crest towards alveolar process (Group A) and the iliac crest towards mandibular inferior margin (Group B). Software was used to measure corresponding indicators. The results obtained for the groups were statistically analyzed.

Results

The study included 78 patients (25 and 53 in groups A and B, respectively). The symmetry of the LC-type defect was better in group A (p < 0.05). The all-bone width of the alveolar process side in group A was greater than 6 mm; in 15 cases of group B, the width was less than 6 mm (p < 0.05). The intermaxillary distance of two sites were higher in group B (p < 0.05). The bone cortical thickness was significantly thicker in group A (p < 0.05).

Conclusion

One year after the mandibular body defect was reconstructed with a vascularized iliac bone flap, the iliac crest towards alveolar process group showed better bone symmetry, width, intermaxillary distance, and cortical thickness to meet the planting requirements.

Clinical relevance

The use of an iliac crest towards alveolar process may be a better approach for mandible reconstruction.

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Data Availability

All data included in this study are available upon request by contact with the corresponding author.

References

  1. Garajei A, Kheradmand AA, Miri SR, Emami A (2021) A retrospective study on mandibular reconstruction using iliac crest free flap. Ann Med Surg (Lond) 66:102354. https://doi.org/10.1016/j.ijom.2008.03.002

    Article  Google Scholar 

  2. Goh BT, Lee S, Tideman H, Lee S, Stoelinga PJ (2008) Mandibular reconstruction in adults: a review. Int J Oral Maxillofac Surg 37(7):597–605. https://doi.org/10.1016/j.ijom.2008.03.002

    Article  Google Scholar 

  3. Foster RD, Anthony JP, Sharma A, Anthony Pogrel M (1999) Vascularized bone flaps versus nonvascularized bone grafts for mandibular reconstruction: an outcome analysis of primary bony union and endosseous implant success. Head Neck 21(1):66–71. https://doi.org/10.1002/(sici)1097-0347(199901)21:1%3c66::aid-hed9%3e3.0.co;2-z

    Article  Google Scholar 

  4. Thoma A, Khadaroo R, Grigenas O, Archibald S, Jackson S, Young JEM, Veltri K (1999) Oromandibular reconstruction with the radial-forearm osteocutaneous flap: experience with 60 consecutive cases. Plast Reconstr Surg 104(2):368–378. https://doi.org/10.1097/00006534-199908000-00007

    Article  Google Scholar 

  5. Brown JS, Lowe D, Kanatas A (2017) Mandibular reconstructionascularizedarised bone flaps: a systematic review over 25 years. Br J Oral Maxillofac Surg 55(2):113–126. https://doi.org/10.1016/j.bjoms.2016.12.010

    Article  Google Scholar 

  6. Taylor GI, Watson N (1978) One-stage repair of compound leg defects with free, revascularized flaps of groin skin and iliac bone. Plast Reconstr Surg 61(4):494–506. https://doi.org/10.1097/00006534-197804000-00002

    Article  Google Scholar 

  7. Qu XZ, Zhang CP, Zhong LP, Ruan M, Zhou SH, Wang MY (2001) Deep circumflex iliac artery flap combined with a costochondral graft for mandibular reconstruction. Br J Oral Maxillofac Surg 49(8):597–601. https://doi.org/10.1016/j.bjoms.2010.10.008

    Article  Google Scholar 

  8. Riediger D (1988) Restoration of masticatory function by microsurgically revascularized iliac crest bone grafts using enosseous implants. Plast Reconstr Surg 81(6):861–877. https://doi.org/10.1097/00006534-198806000-00007

    Article  Google Scholar 

  9. Yilmaz M, Vayvada H, Menderes A, Demirdover C, Kizilkaya A (2008) A comparison of vascularized fibular flap and iliac crest flap for mandibular reconstruction. J Craniofac Surg 19(1):227–234. https://doi.org/10.1097/scs.0b013e31815c942c

    Article  Google Scholar 

  10. Jewer D, Boyd JB, Manktelow RT, Zuker RM, Rosen IB, Gullane PJ, Rotstein LE, Freeman JE (1989) Orofacial and mandibular reconstruction with the iliac crest free flap: a review of 60 cases and a new method of classification. Plast Reconstr Surg 84(3):391–403. https://doi.org/10.1097/00006534-198909000-00002

    Article  Google Scholar 

  11. Thiesen G, Freitas MPM, Gribel BF, Kim KB (2019) Comparison of maxillomandibular asymmetries in adult patients presenting different sagittal jaw relationships Dental Press. J Orthod 24(4):54–62. https://doi.org/10.1590/2177-6709.24.4.054-062.oar

    Article  Google Scholar 

  12. Lonic D, Sundoro A, Lin HH, Lin PJ, Lo LJ (2017) Selection of a horizontal reference plane in 3D evaluation: identifying facial asymmetry and occlusal cant in orthognathic surgery planning. Sci Rep 7(2157):1–9. https://doi.org/10.1038/s41598-017-02250-w

    Article  Google Scholar 

  13. Alonso-Gonzalez R, Aloy-Prosper A, Penarrocha-Oltra D, Penarrocha-Diago M, Penarrocha-Diago M (2012) Marginal bone loss in relation to platform switching implant insertion depth: an update J Clin Exp. Dent 4(3):173–179. https://doi.org/10.4317/jced.50743

    Article  Google Scholar 

  14. Li L, Blake F, Heiland M, Schmelzle R, Pohlenz P (2007) Long-term evaluation after mandibular reconstruction with fibular grafts versus microsurgical fibular flaps. J Oral Maxillofac Surg 65(2):281–286. https://doi.org/10.1016/j.joms.2006.08.009

    Article  Google Scholar 

  15. Croker SL, Reed W, Donlon D (2016) Comparative cortical bone thickness between the long bones of humans and five common non-human mammal taxa. Forensic Sci Int 260(104):1–17. https://doi.org/10.1016/j.forsciint.2015.12.022

    Article  Google Scholar 

  16. Liu J, Pan S, Dong J, Mo Z, Fa NY, Feng H (2013) Influence of implant number on the biomechanical behaviour of mandibular implant-retained/supported overdentures: a three-dimensional finite element analysis. J Dent 41(3):241–249. https://doi.org/10.1016/j.jdent.2012.11.008

    Article  Google Scholar 

  17. Melnik AK (1992) A cephalometric study of mandibular asymmetry in a longitudinally followed sample of growing children. Am J Orthod Dentofacial Orthop 101(4):355–366. https://doi.org/10.1016/S0889-5406(05)80329-4

    Article  Google Scholar 

  18. Han K, Kim J (2001) Reduction mandibuloplasty: ostectomy of the lateral cortex around the mandibular angle. J Craniofac Surg 12(4):314–325. https://doi.org/10.1097/00001665-200107000-00004

    Article  Google Scholar 

  19. Zhang M, Rao P, Xia D, Sun L, Cai XX, Xiao JG (2019) Functional reconstruction of mandibular segment defects with individual preformed reconstruction plate and computed tomographic angiography-aided iliac crest flap. J Oral Maxillofac Surg 77(6):1293–1304. https://doi.org/10.1016/j.joms.2019.01.017

    Article  Google Scholar 

  20. Modabber A, Möhlhenrich SC, Ayoub N, Hajji M, Raith S, Dds SR, Steiner T, Ghassemi A, Hölzle F (2015) Computer-aided mandibular reconstruction with vascularized iliac crest bone flap and simultaneous implant surgery Journal of. Oral Implantol 41(5):189–194. https://doi.org/10.1563/aaid-joi-D-13-00341

    Article  Google Scholar 

  21. Al-Johany SS, Al-Amri MD, Alsaeed S, Alalola, (2017) Dental implant length and diameter: a proposed classification scheme. J Prosthodont 26(3):252–260. https://doi.org/10.1111/jopr.12517

    Article  Google Scholar 

  22. Chiapasco M, Romeo E, Coggiola A, Brusati R (2011) Long-term outcome of dental implants placed in revascularized fibula free flaps used for the reconstruction of maxillo-mandibular defects due to extreme atrophy. Clin Oral Implant Res 22(1):83–91. https://doi.org/10.1111/j.1600-0501.2010.01999.x

    Article  Google Scholar 

  23. Shimizu T, Ohno K, Matsuura M, Segawa K, Michi KI (2002) An anatomical study of vascularized iliac bone grafts for dental implantation. J Cranio Maxill Surg 30(3):184–188. https://doi.org/10.1054/jcms.2002.0299

    Article  Google Scholar 

  24. Lvarez-Arenal N, Segura-Mori L, Gonzalez-Gonzalez I, DeLlanos-Lanchares H, Sanchez-Lasheras F, Ellacuria-Echevarria J (2016) Stress distribution in the transitional peri-implant bone in a single implant-supported prosthesis with platform-switching under different angulated loads. Odontology 105(1):1–8. https://doi.org/10.1007/s10266-016-0237-6

    Article  Google Scholar 

  25. Lan TH, Du JK, Pan CY, Lee HE, Chung WH (2012) Biomechanical analysis of alveolar bone stress around implants with different thread designs and pitches in the mandibular molar area. Clin Oral Invest 16(2):363–369. https://doi.org/10.1007/s00784-011-0517-z

    Article  Google Scholar 

  26. Brown JS, Jones DC, Summerwill A, Rogers SN, Howell RA, Cawood JI, Vaughan ED (2002) Vascularized iliac crest with internal oblique muscle for immediate reconstruction after maxillectomy. Br J Oral Maxillofac Surg 40(3):183–190. https://doi.org/10.1054/bjom.2001.0774

    Article  Google Scholar 

  27. Kuzbari R, Worseg A, Burggasser G, Schlenz I, Holle J (1997) The external oblique muscle free flap. Plast Reconstr Surg 99(5):1338–1345. https://doi.org/10.1097/00006534-199704001-00021

    Article  Google Scholar 

  28. Hao Y, Gao C, Yue T, Yang X, Kai S (2018) Reconstruction of anterior mandible and mouth floor using the myofascial iliac crest free flap after tumor resection. Ann Plast Surg 82(4):411–414. https://doi.org/10.1097/SAP.0000000000001649

    Article  Google Scholar 

  29. Ayoub N, Ghassemi A, Rana M, Gerressen M, Riediger D, Hölzle F, Modabber A (2014) Evaluation of computer-assisted mandibular reconstruction with vascularized iliac crest bone graft compared to conventional surgery: a randomized prospective clinical trial. Trials 15(1):114. https://doi.org/10.1186/1745-6215-15-114

    Article  Google Scholar 

  30. Ghassemi A, Furkert R, Prescher A, Riediger D, Gerressen M (2013) Variants of the supplying vessels of the vascularized iliac bone graft and their relationship to important surgical landmarks. Clin Anat 26(4):509–521. https://doi.org/10.1002/ca.22199

    Article  Google Scholar 

  31. Jewer DD, Boyd JB, Manktelow RT, Zuker RM, Rosen IB, Gullane PJ, Rotstein LE, Freeman JE (1989) Orofacial and mandibular reconstruction with the iliac crest free flap: a review of 60 cases and a new method of classification. Plast Reconstr Surg 84(3):391–403. https://doi.org/10.1097/00006534-198909000-00002

    Article  Google Scholar 

  32. Christian M, Christian D, Michael E, Anja S, Jürgen H, Kolja F (2014) Early bone resorption of free microvascular reanastomized bone grafts for mandibular reconstruction—a comparison of iliac crest and fibula grafts. J Cranio-Maxillo-Facial Surg 42(5):217–223. https://doi.org/10.1016/j.jcms.2013.08.010

    Article  Google Scholar 

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Funding

This study received financial support from the Special Scientific Research Project of Capital Health Development (CFH2020-2–4102) and the National Multidisciplinary Cooperative Diagnosis and Treatment Capacity Building Project of Peking University School and Hospital of Stomatological for Major Diseases (PKUSSNMP-202015).

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Peking University School and Hospital of Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People’s Republic of China

    Zong-Yan Yang, Yi-Fan Kang, Xiao-Ming Lv, Jian-Feng LiuFu, Lei Zhang, Xiao-Feng Shan & Zhi-Gang Cai

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  1. Zong-Yan Yang
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Corresponding author

Correspondence to Xiao-Feng Shan.

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Ethical approval

This study has been approved by the Institutional Ethics Committee, Peking University School and Hospital of Stomatology (PKUSSIRB–202060207).

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For this type of study, formal consent is not required.

Conflict of interest

The authors declare no competing interests.

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Yang, ZY., Kang, YF., Lv, XM. et al. Iliac crest towards alveolar processes or mandibular inferior margin in mandibular reconstruction with a vascularized iliac bone flap: which is better?. Clin Oral Invest 27, 751–758 (2023). https://doi.org/10.1007/s00784-022-04823-0

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