Mandibular Reconstruction with Non-Vascularized Iliac Crest Bone Graft After Resection for Ameloblastoma: Outcomes at Ahmadu Bello University Teaching Hospital

Segmental resection for ameloblastoma results in significant mandibular continuity defects that require osseous reconstruction to restore function and facial contour. In the Nigerian context, where microsurgical free flap reconstruction is not universally available, non-vascularized iliac crest bone graft (NVIBG) represents an accessible and practical reconstructive option. This prospective clinical study evaluates the success rates, functional outcomes, and predictors of graft failure for NVIBG in mandibular reconstruction following ameloblastoma resection at Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, North West Nigeria. Twenty-eight consecutive patients who underwent NVIBG reconstruction between 2018 and 2023 were followed for a minimum of 24 months. Primary outcome was graft success defined as radiographic evidence of osseous union at six months. Secondary outcomes include infection, graft exposure, facial symmetry, mouth opening, and recurrence of ameloblastoma. Graft success was achieved in 75% of cases. Predictors of failure included defect length greater than 5cm, postoperative wound infection, and patient non-compliance with prophylactic antibiotic regimens. Smoking was a significant independent predictor of graft failure. The study demonstrates acceptable outcomes with NVIBG in a resource-limited setting and supports continued use of this technique for moderate mandibular defects while acknowledging the limitations compared to vascularized grafts. Recommendations include structured patient selection criteria and improved postoperative monitoring protocols at ABUTH. Keywords: mandibular reconstruction, iliac crest bone graft, ameloblastoma, Zaria, osseous reconstruction.