Factors influencing the long-term outcome of mandibular reconstruction

Purpose: The aim of this study was to understand the association of 30 cand idate 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 al l patients. Thirty variables, including patient factors, preoperative prepa ration, and intraoperative and postoperative findings were determined for e ach 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 yea r and 2) proportional hazard regression models were then used to identify t he predictors of bone graft survival time from the 30 chosen variables. Results: Multivariate analysis determined that greater blood loss during th e procedure (P =.018) and the presence of postoperative recipient site comp lications (P =.010) were significantly associated with bone graft failure d uring 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 signi ficant predictors of graft survival time in the proportional hazard regress ion model. Conclusions: The analysis of parameters associated with bone graft outcome may aid in surgical decision making and help improve the likelihood of a su ccessful result in the future. (C) 2000 American Association of Oral and Ma xillofacial Surgeons.