The use of free autogenous rib grafts in maxillofacial reconstruction.

SUMMARY BACKGROUND

Hard tissue defects in the maxillofacial region due to trauma or ablative surgery result in functional and cosmetic problems. State-of-the-art methods for reconstruction include the use of vascularised tissue.

OBJECTIVE

To review our results with the use of non-vascularised rib grafts for maxillofacial reconstruction.

METHOD

Patients who underwent maxillofacial reconstruction using rib at the Komfo Anokye Teaching Hospital during 1996-2004 were studied. The technique for rib harvest and implantation of the graft was standardized. Clindamycin was administered peri-operatively and the harvested rib was temporarily stored in clindamycin/saline before implantation. The graft was successful if it survived beyond 6 months after placement. Follow-up was for at least 12months postoperatively.

RESULTS

A total of 29 patients were studied. The indications for grafting included ameloblastoma, malignant disease, cyst, ankylosis, and trauma. Either rib bone only or with cartilage were used. In 90% of patients (26/29) the graft healed uneventfully. Two patients had dehiscence of the wound with exposure of the graft intraorally within two weeks of surgery and were successfully managed with antibiotics.

CONCLUSION

Free autogenous rib was successfully used to reconstruct defects in the maxillofacial region. Further stabilization of the graft by intermaxillary fixation and the prophylactic use of clindamycin may have helped to minimize complications.