Vascularised versus Non Vascularised Autogenous Bone Grafts for Immediate Reconstruction of Segmental Mandibular Defects: A Systematic Review

The mandible is very important for facial aesthetics and is also responsible for mastication and speech. Resection of the mandible is often indicated in the treatment of some infections, odontogenic tumors, severe trauma and oral cancer that represent a great challenge for surgeons because of the complexity and unique anatomy of the mandible. The main target of reconstruction of discontinuity defects of the mandible is to restore cosmetics, maximize function, mastication and preserve appearance and quality of life. Treatment of segmental mandibular defects is considered a complex process. Various techniques of reconstruction, ranging from simple bridging plates to composite free flaps have been adopted; each has its advantages and disadvantages. Till now, autogenous bone grafts is still considered to be the gold Standard and the most preferred method in reconstruction of such defects. There are various forms of the autogenous bone grafts either vascularised, non vascularised or pedicled flaps depending on the type of the defect required to be reconstructed, the most popular donor sites for free non vascularised grafts are the iliac crest; either anterior or posterior; and costochondral (rib grafts). Mandible reconstruction was revolutionized by the introduction of micro-vascular surgery, and the subsequent development of vascularised bone grafts. The evolution began with the initial development of vascularised iliac crest graft, later followed by vascularised fibula, radial forearm, and scapula grafts. These types of grafts led to the high success rate and significantly improved functional outcome seen in mandible reconstruction today.