Fibular free flap reconstruction for the management of advanced bilateral mandibular osteoradionecrosis.

Fibular osteoseptocutaneous flap has been widely used for unilateral mandibular reconstruction. However, reports about the effects of fibular osteoseptocutaneous flap for the reconstruction of bilateral mandibular defects are limited. In this study, we used free vascularized fibular flaps to successfully manage bilateral mandibular osteoradionecrosis(ORN) in 5 patients. Functional aspects were evaluated during the reconstruction process. All 5 patients had bilateral refractory ORN of the mandible and underwent radical resection between 2003 and 2011. The reconstruction surgery was performed in 2 stages using 2 free fibular flaps in 3 patients. In the other 2 patients, reconstruction was performed in a single stage using 2 separate flaps prepared from a single fibula. All patients had a healthy mandibular symphysis and meniscus of the temporomandibular joint, and these structures were preserved during the reconstruction.Of the 10 defects involving the mandible sides, 9 were successfully reconstructed. One microvascular composite flap failed because of radiation injury to the arterial endothelium at the recipient site. After the treatments, all patients had good esthetic and functional outcomes. Preoperative clinical features such as trismus and dysphagia were also markedly improved. Our surgical method may be an effective alternative for the clinical management of advanced bilateral mandibular ORN.

[Retrospective study of 93 patients with jaw osteoradionecrosis].

OBJECTIVE: To investigate the clinical feature, treatment, and prognosis of hospitalized patients with jaw osteoradionecrosis. METHODS: A total of 93 cases with jaw osteoradionecrosis treated between 2000 and 2010 was reviewed. Of the 93 cases, 79 cases were with mandible lesions, 13 cases with maxillary lesions, and 1 case with both mandible and maxillary lesions. Sixty-six cases received one course of radiotherapy, with the radiation doses of 34 - 90 Gy (mean 64.6 Gy). Twenty-two cases experienced tooth extraction or other operative procedures before exhibition of the clinical symptoms for osteoradionecrosis. The interval time between radiotherapy and the onset of osteoradionecrosis varied from 2 weeks to 32 years (mean 54 months). RESULTS: Of 93 cases, 56 patients underwent radical resection of the pathologic bone and reconstruction with free tissue flaps, in whom 7 cases received the second surgery due to microvascular thrombosis in flap vessels, and flaps were survival by new vascular anastomosis in 3 cases, the failed flaps were removed and replaced successfully by non vascularized bone grafts in 2 cases, and the failed flaps removed and the defects were repaired with adjacent skin in other 2 cases. In the 56 cases, only one case was with disease recurrence and 53 cases with significant improvement in chewing and swallowing functions. Only 2 of 93 cases underwent resection of the pathologic bone and reconstruction with titanium plates, and thereafter they encountered titanium exposure. Scaling of osteoradionecrosis lesions was applied to 20 of 93 patients and 9 cases of them were with disease recurrence. Fifteen cases had resection of the effected mandible without reconstruction. Disease relapse was encountered in 2 of them, others had poor chewing and swallowing. CONCLUSIONS: The mandible is more susceptible to osteoradionecrosis than maxilla. Radical resection with reconstruction by free tissue flap is recommended for the treatment of jaw osteoradionecrosis, and scaling and reconstruction only with titanium plate should be avoided because of high risks of titanium exposure and disease relapse.