The use of immediate bone grafting in reconstruction of clinically infected mandibular fractures

Bone grafts in the presence of pus

Paul D. Benson, Melanie K. Marshall, Mark Engelstad, George M. Kushner, Brian Alpert

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Purpose: Current approaches to the treatment of infected mandibular fractures include antibiotics, drainage, immobilization of the segments, and debridement followed by secondary bone grafting of residual defects once the infection is resolved and the wound healed. Over the past 30 years, the time from debridement to grafting has diminished from several months to a few weeks. We present our experience with a treatment model managing clinically infected fractures of the mandible with antibiotics, debridement, rigid internal fixation, and immediate autogenous bone grafting. Materials and Methods: In this retrospective study, we present a series of 43 patients who demonstrated clinical/laboratory findings consistent with infection in one or more mandibular fractures (50 infected fractures). These patients underwent a combination of incision and drainage, fracture debridement, rigid internal fixation, and immediate bone grafting of the resulting defect in a single stage. Both transoral and transfacial approaches were used. Results: Of the 50 fractures, 43 showed both resolution of infection and bony union of fractures with long-term follow-up of 2 months to 4 years. Four fractures developed recurrent infection but proved to have bony union and were successfully treated by hardware removal only. Three other patients were deemed failures with persistent infection, loss of graft, nonunion, and need for retreatment. Each of these patients was afflicted with underlying immunocompromise. Conclusions: Although careful patient selection is a must, immediate bone grafting of infected mandibular fractures, when used in conjunction with rigid internal fixation and appropriate intraoperative debridement, is an effective treatment modality which allows a single surgical procedure and dramatically shortens the course of treatment.

Original languageEnglish (US)
Pages (from-to)122-126
Number of pages5
JournalJournal of Oral and Maxillofacial Surgery
Volume64
Issue number1
DOIs
StatePublished - Jan 2006
Externally publishedYes

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Mandibular Fractures
Bone Transplantation
Suppuration
Debridement
Transplants
Bone and Bones
Infection
Drainage
Anti-Bacterial Agents
Retreatment
Therapeutics
Mandible
Immobilization
Patient Selection
Retrospective Studies
Wounds and Injuries

ASJC Scopus subject areas

  • Dentistry(all)
  • Surgery

Cite this

The use of immediate bone grafting in reconstruction of clinically infected mandibular fractures : Bone grafts in the presence of pus. / Benson, Paul D.; Marshall, Melanie K.; Engelstad, Mark; Kushner, George M.; Alpert, Brian.

In: Journal of Oral and Maxillofacial Surgery, Vol. 64, No. 1, 01.2006, p. 122-126.

Research output: Contribution to journalArticle

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