Complete rehabilitation of the mandible following segmental resection

Abstract

Segmental resection of the mandible leads to significant patient morbidity. Loss of mandibular support to the teeth, tongue and lip causes dysfunctional mastication, swallowing, speech, airway protection and oral competence. Patients also suffer disfigurement following segmental mandibulectomy because the mandible is an important aesthetic landmark. The degrees to which dysfunction and disfigurement occur depend both on the location of the mandibular segment removed and the amount of surrounding soft tissue excised. Between January 1985 and December 2004, 780 fibula osteoseptocutaneous flaps have been used for head and neck reconstruction at the Chang Gung Memorial Hospital, Taiwan. The fibula flap has proven to be the bony flap of choice because it has a lengthy bicortical segment of bone available, a reasonably long vascular pedicle, large diameter vessels, good bone quality, and is easily contoured with multiple osteotomies. The flap can be harvested while ablation is being performed. In addition, a reliable, mobile, thin skin component can always be included to address the soft tissue reconstructive requirements. A chimeric design employing a portion of the soleus muscle can provide further reconstructive options. Ideally complete rehabilitation of the mandible involves placement of titanium osseointegrated implants, which allow dental restoration. Primary placement of implants is preferred in patients without cancer. Selection of candidates to receive osseointegrated implants is paramount. The temporomandibular joint remains a challenge to reconstruct adequately.

Mandibular reconstruction using free bone flap after preoperative chemoradiation

“…The results have improved considerably after introducing microvascular bone flaps, out of which the fibular flap has become the most popular one [2,5,6]. For the good control of the head and neck cancer of advanced stage, the combination of surgery and chemoradiation has been shown to be beneficial, but the success of microvascular flaps combined with radiation therapy divides opinions and is presumed to be time and dose dependent [6][7][8]12].…”

“…In diseases of advanced stage, postoperative irradiation or chemoradiation is commonly combined with surgery. Vascularized free bone flaps have more or less replaced other methods in reconstruction after segmental mandibulectomy [2,3]. Many donor sites have been used for microvascular reconstruction of mandibular defects, but during the last 20 years fibular free flap has been established as the most popular technique for reconstruction of segmental defects of mandibular area [4,5].…”

Rehabilitation after mandibular reconstruction with fibula free-flap: clinical outcome and quality of life assessment

“…SCHRAG et al presented the Taiwan experience of 780 cases of OFFF and recommended implant-based rehabilitation but did not comment on patient numbers 18 . PELED et al presented 13 consecutive patients with fibular mandibular reconstruction but only 2 had implant placement; the reasons for this were not stated 13 .…”

Microvascular Free Flaps in Oral and Maxillofacial Reconstruction following Cancer Ablation

“…34 Also since the sural nerve lies in the same donor area as the harvesting site; it is simultaneously possible to harvest the sural nerve in patients who are planned for reconstruction of inferior alveolar nerve. 35 A clinical example of the fibular free tissue flap being harvested to reconstruct the composite resection is shown in (Figure 3). …”