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One of the more difficult problems in reconstructive surgery of the head and neck is replacement of bone and soft tissue lost because of injury, osteomyelitis, or malignancy. The radial-forearm osteocutaneous flap is an accepted choice for oromandibular reconstruction. This study was undertaken to review one center's experience with 60 consecutive cases of oromandibular reconstruction with the radial-forearm osteocutaneous flap. Records of the 38 men and 22 women (mean age, 60 years; range, 26 to 86 years) were reviewed for tumor location, defect and bone length, flap failure rate, recipient- and donor-site complications, length of surgery, and hospital stay. Cancer resection was the reason for 97 percent of reconstructions; 33 percent of flaps were used to reconstruct a lateral defect of the mandible, 40 percent a lateral-central defect, and 27 percent a lateral-central-lateral defect. Mean skin flap size was 55 cm2 (range, 15 to 117 cm2) and mean bone length, 9.4 cm (range, 5 to 14 cm). The microvascular success rate was 98.3 percent. Complications included fracture of the donor radius (15 percent), nonunion of the mandible (5 percent), and hematoma (8.3 percent). These results are comparable to results reported in the literature with other radial forearm flaps. The free radial osteocutaneous flap is a safe and reliable choice for mandibular reconstruction. It offers sufficient bone to reconstruct large defects and can provide adequate pedicle length for vessel anastomosis to the contralateral side of the neck. The above attributes make the radial forearm osteocutaneous flap one of the "first line" flap choices for oromandibular reconstruction.

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This prospective case-matched study suggests that there may be significant QOL benefits, including decreased anxiety, pain, and depression and increased appetite and generalized feelings of well-being, associated with marijuana use among patients with newly diagnosed HNC.

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The sternocleidomastoid (SCM) muscle has been used in various ways for reconstruction following cancer resections in the head and neck. Its use has been restricted because of the presumed precarious nature of its blood supply and its proximity to disease. Patients with large or recurrent benign parotid tumors were the first in our series to have a SCM muscle flap (either superiorly or inferiorly based) used to improve cosmesis. After demonstrating the utility of these flaps, we extended the indications for their use to include patients with primary or recurrent malignant disease. The flaps provide soft tissue contour, coverage of facial nerves and nerve grafts, act as a healthy bed for skin grafts, and help close salivary fistulas. There were no complications attributed to the flaps. This paper discusses 31 patients with benign and malignant parotid disease in whom the SCM flap was used.