Factors influencing the long-term outcome of mandibular reconstruction

Purpose: The aim of this study was to understand the association of 30 candidate variables with the outcome of mandibular reconstruction. Patients and Methods: Seventy cases of mandibular reconstruction performed between 1976 and 1991 were identified. Medical records were reviewed for all patients. Thirty variables, including patient factors, preoperative preparation, and intraoperative and postoperative findings were determined for each patient. Bone graft outcome was evaluated in 2 ways: 1) Fisher's exact tests and logistic regression models were used to determine the association between the clinical parameters and the success of the bone graft at 1 year and 2) proportional hazard regression models were then used to identify the predictors of bone graft survival time from the 30 chosen variables. Results: Multivariate analysis determined that greater blood loss during the procedure (P = .018) and the presence of postoperative recipient site complications (P = .010) were significantly associated with bone graft failure during the first year. The diagnosis of malignant disease (P = .006), the use of sternocleidomastoid muscle (SCM) flaps for soft tissue augmentation (P < .001), longer duration of suction drainage (P = .001), and the presence of postoperative recipient site complications (P = .013) were found to be significant predictors of graft survival time in the proportional hazard regression model. Conclusions: The analysis of parameters associated with bone graft outcome may aid in surgical decision making and help improve the likelihood of a successful result in the future. (C) 2000 American Association of Oral and Maxillofacial Surgeons.