Increased rate of pseudarthrosis in the anterior intersegmental gap after mandibular reconstruction with fibula free flaps : a volumetric analysis

Journal
Dentomaxillofacial radiology  
Volume
51
Issue
7
Article Number
20220131
Citation
Dentomaxillofacial Radiology 51 (7): 20220131 (2022)
Publisher DOI
10.1259/dmfr.20220131
Scopus ID
2-s2.0-85138491110
Publisher
British Institute of Radiology
Objectives: Pseudarthrosis after mandibular reconstruction leads to chronic overload of the osteosynthesis and impedes dental rehabilitation. This study evaluates the impact of gap site on osseous union in mandible reconstruction using a new volumetric analysis method with repeated cone-beam computed tomography (CBCT). Methods: The degree of bone regeneration was evaluated in 16 patients after mandible reconstruction with a fibula free flap and patient-specific reconstruction plates. Percentual bone volume and width changes in intersegmental gaps were retrospectively analyzed using a baseline CBCT in comparison to a follow-up CBCT. Patients’ characteristics, plate-related complications, and gap sites (anterior/posterior) were analyzed. Detailed assessments of both gap sites (buccal/lingual/superior/inferior) were additionally performed. Results: Intersegmental gap width (p = 0.002) and site (p < 0.001) significantly influence bone volume change over two consecutive CBCTs. An initial larger gap width resulted in a lower bone volume change. In addition, anterior gaps showed significantly less bone volume changes. Initial gap width was larger at posterior segmental gaps (2.97 vs 1.65 mm, p = 0.017). Conclusions: A methodology framework has been developed that allows to quantify pseuarthrosis in reconstructed mandibles using CBCT imaging. The study identifies the anterior segmental gap as a further risk factor for pseudarthrosis in reconstructions with CAD/CAM reconstruction plates. Future research should evaluate whether this outcome is related to the biomechanics induced at this site. Dentomaxillofacial Radiology (2022) 51, 20220131. doi: 10.1259/dmfr.20220131
Subjects
Cone-Beam Computed Tomography
Fibula
Mandibular reconstruction
Pseudarthrosis
Surgical Flaps
DDC Class
610: Medicine, Health