[Autologous rib graft for restoration of continuity defects of the mandible].

Background: Reconstruction of mandibular defects following tumor resection in infants is a particular challenge. Although autologous rib grafts have no relevance nowadays for restoration of mandibular bone defects following ablative tumor surgery due to limited bone stock and the availability of other donor areas, they are a useful surgical alternative following tumor surgery in infants.
Patients and Method: We here report on the 5- and 10-year follow-up of two children who were diagnosed with benign tumors of the mandible with osseous destruction at the age of 4 and 6 months, respectively. Histological diagnoses were melanotic neuroectodermal tumor and hemangioendothelioma of the mandible. Following continuity resection of the mandible lateral mandibular bone defects were restored using autologous rib grafts. Yearly clinical and radiological follow-up visits in both children were performed to assess growth of the facial skeleton as well as mandibular growth.
Result: Cephalometric measurements on panorex films as well as 3D CT scans revealed slight vertical growth excess and transversal growth inhibition of the reconstructed mandible in comparison with the non-operated side.
Discussion: Although further growth of rib grafts is difficult to predict and occlusal disharmony may occur due to physiologic maxillary growth and growth of the unaffected mandible, we believe that autologous rib grafts can be ideally used for restoration of mandibular continuity defects in newborns. Clinical follow-up visits on a yearly basis and orthodontic controls are useful for early orthodontic treatment of growth deficits. Further corrective surgery with bone augmentation or osseous distraction is required following completion of growth of the facial skeleton.