Condylar autograft with fibular free flap for mandibular reconstruction

ABSTRACT

DESIGN: Surgical Innovation SETTING: Academic Tertiary Hospital OBJECTIVE: The objective of the study was to describe an alternative technique using a condylar autograft in conjunction with a fibular free flap in mandibular reconstruction and to prospectively assess the functional outcome in terms of inter-incisal distance, lateral excursion, maximum protrusion, occlusion, type of diet, speech and mandibular contour. METHODOLOGY: All patients who underwent segmental mandibulectomy with fibular free flap reconstruction done by one microvascular team from 1997 to 2004 were reviewed. From a total of 38 patients who underwent fibular free flap reconstruction, 7 patients who had condylar disarticulation, rigid fixation using miniplates to the fibula then replacement into the glenoid fossa were identified but 2 patients were excluded due to poor follow-up. Functional outcomes in terms of inter-incisal distance, lateral excursion, maximum protrusion, occlusion, type of diet, speech and mandibular contour were assessed post-operatively. Presence of tumor recurrence was also noted. RESULTS: Five patients were included in the study. The inter-incisal distance was noted to be 31 mm (+/- 12.5) with maximum protrusion of 1.4 mm (+/- 0.9). For those with right hemimandibulectomy (n=2), the right lateral excursion was 2.34mm (+/- 3.3) and left lateral excursion was 1.66mm (+/- 2.35). For those with left hemimandibulectomy (n=3), the right lateral excursion was 8.17m (+/- 2.25) and left lateral excursion was 3 mm (+/- 2.65). Four out of 5 patients had normal diet with excellent intelligible speech. The same 4 patients had good mandibular contour with a Class I occlusion as assessed by a dentist. The only patient with fair outcome had a mucoepidermoid carcinoma of the floor of the mouth with extensive soft tissue reconstruction aside from the bony reconstruction. No patient had tumor recurrence. CONCLUSION: The use of condylar autograft in conjunction with fibular free flaps holds promise as a way to restore temporomandibular function in mandibular reconstruction. (Author)