The restoration of resected mandibles in children without the use of bone grafts.

Following resection of the mandible for various types of neoplastic disease, six patients between the ages of 5 and 14 were followed for a period of 8 to 12 years after osseous surgical reconstructive surgery. It was found in children of this age group that a surgical technique may be employed which will effect complete bone regeneration without the use of bone graft materials. All six of the patients spontaneously regenerated large segments of the mandible from full-body ostectomy to hemimandibulectomy defects. The surgical procedure involves the use of a titanium mesh implant between the ostectomized bone fragments to maintain the surrounding soft tissues in a distracted position. It is found that if the soft tissues of the growing child are surgically prepared using the described technique, a new periosteum and bone will be formed along the titanium mesh implant. The titanium mesh may be removed at a later date or, depending on its method of placement, may be allowed to remain as the child grows, regenerating additional bone structure. It was found that in only one case was additional grafting necessary to obtain osseous union between the spontaneously regenerated mandibular bone and the host-bone ostectomized fragments. The technique is advocated for bone restoration in cases of large osseous discontinuity defects of the mandible in children.