Sliding osteotomy for reconstruction of short post-gunshot mandibular defects < 2 cm: a prospective case series and narrative literature review
摘要
Reconstruction of short mandibular defects (< 2 cm) remains controversial, as these defects lie within a clinical “gray zone” between spontaneous healing and the need for surgical intervention. In cases of compromised soft tissues, particularly following gunshot injuries, conventional approaches such as bone grafting or microsurgical reconstruction may be suboptimal. This study aimed to evaluate the outcomes of sliding osteotomy (SO) techniques for reconstruction of post-gunshot short mandibular defects.
MethodsThis prospective case series included 10 patients with post-traumatic gunshot mandibular defects < 2 cm treated with SO techniques between March 2023 and September 2025. Clinical data, surgical characteristics, complications, and prosthetic outcomes were analyzed descriptively. A narrative literature review on SO techniques in mandibular reconstruction was also performed.
ResultsThe mean defect length was 1.29 ± 0.22 cm. Most patients had a history of previous surgical interventions, including prior fracture fixation, failed bone grafting, and debridement. Horizontal SO was performed in 60.0% of cases and sagittal SO in 40.0%. Reconstruction failure due to non-union/fibrous union occurred in 2/10 patients (20.0%). Both patients required secondary mandibular reconstruction with a fibula free flap, which had been completed in one case at the time of evaluation.
ConclusionsSO appears to be a technically straightforward option for reconstruction of short mandibular defects, particularly in patients with compromised soft tissue conditions or failed prior grafting. It may represent a salvage alternative within the reconstructive armamentarium for managing small but clinically critical defects.
Trial registrationNot applicable. This was an observational prospective case series and did not involve prospective assignment of participants to an intervention.