[Tumors of the mandible. Justification of a second reconstruction after recurrence on the first revascularized bone graft].

The use of free vascularized bone grafts for mandibular reconstruction has led to a consideration of the new entity of recurrent tumour on bone grafts. Exeresis of the mandible was performed in 4 patients with bone tumours: osteosarcoma 1, osteochondroma 1, carcinoma 1 and ameloblastoma 1. A free vascularized bone graft was used for the reconstruction. Tumours recurred with a delay of 10 to 18 months after the initial reconstruction. The frequency of tumoural recurrence can be measured in our series of 46 patients (24 with fibular grafts, 15 with scapular grafts, 4 with radius grafts and 3 with iliac bone grafts). Recurrence rate at our institution was 4.3%. The 2 other cases involved patients from other institutions. The main factor involved in tumoural recurrence is the aggressive nature of the primary tumours, even after extensive initial resection as performed in our patients. Free bone grafts were invaded as were neighbouring tissues. Secondary reconstruction of the mandible was performed in 3 cases with a fibula graft. In the fourth patient, no operation was possible due to the diffuse nature of the invasion and the poor status of the patient's vessels and general health. Local extension, and not the tumour histology, is the main factor in deciding upon reoperation. The explosive nature of recurrences is linked more to the aggressive character of the tumour than to the status of the revascularized free bone graft. Secondary reconstruction is justified after recurrence on bone grafts depending on the complexity of the major resection involving extensive tissue exeresis.(ABSTRACT TRUNCATED AT 250 WORDS)