[Evaluation of the usefulness of autogenic bone grafts in reconstruction of the mandible].

The treatment of reconstructions of mandible by means of autogenic bone graft in 64 patients has been presented (Fig. 1). In 55 cases the bone material was taken from the iliac crest, in 5--the skin-muscle flap, in 4--the free bone graft from VIII rib and tibial bones. The resection in 47 patients was performed because of malignant neoplasms, in 4 cases--oral and mandibular benign neoplasms, in 3 cases a part of the mandible was resected because of the osteodystrophy, in 3 cases due to osteoradionecrosis, in 3 cases--congenital anomalies, in 2 cases because of a cyst, while in other 2--after an injury. Clinical parameters were evaluated: cosmesis, mastication, deglutition, diet, speech, and the use of dentures. The positive result was obtained in 84% cases. Cosmesis was improved in patients who had immediate restoration of mandibular reconstruction due to previous scarring. Mastication was poorer in the reconstructed group due to scarring, loss of the muscles of mastication, and inhibition of compensation of mandibular motion. Deglutition was not improved in patients who had mandibular continuity resorbed. Problems with deglutition were related to soft tissue resection. Speech and prosthetic rehabilitation was poor in both groups in patients. In 5% of patients, there was a slight extraoral graft denudation and the development of organic inflammatory process in the surrounding tissues and the graft itself. Application of the appropriate pharmacological and local treatments was sufficient for the maintenance of the graft and its normal healing. Negative result of the mandible reconstruction was observed in 11% of cases. In the patients with immediate reconstruction, more than 50% of the bone grafts resorbed.