Remodelling of mandibular bony defects following fracture or reconstructive surgery is not well understood. Perilesional osteopenia (PO) has been described in regeneration of long bone fractures and is thought to be part of the normal ossification process. This study investigated radiographic progression of mandibular healing at osteotomy and fracture sites. A retrospective record review (CT scans) was conducted on patients who underwent mandibular reconstruction over a ten-year period (2001–2012). Matched-pair sequential CT scans at 3 months intervals were included in the analysis. Bone density measurements, reported as Hounsfield Units (HU), were obtained at the cortical margins as well as the gap at each osteotomy/fracture site. Perilesional osteotomy gap changes and bone densities were compared over time. PO was defined as a decrease in bone density greater than 50 HU. PO was observed in 63% (14/22) of reconstructive junctions and 62% (18/29) of fracture junctions. In patients reconstructed with free fibula flaps 59% (10/17) of the native mandible-graft junctions demonstrated PO compared to 80% (4/5) of the graft-graft junctions. The results of this study propose a method for monitoring healing in mandibular reconstruction and suggest that PO appears to be part of the normal osseous regeneration of the mandible.
Perilesional osteopenia due to increased cortical remodelling following mandibular osteotomies and fractures
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