Reconstruction of the marginal mandibulectomy defect: an update

Mylohyoid advancement flap for closure of composite oral cavity defects

“…The majority of our patients were restarted on an oral diet by postoperative day 1, with two needing supplementation through gastrostomy tube. This quick return to oral intake is in part due to circumventing the placement of an overlying bolster of the skin graft, which a number of authors favor 2. It had been believed that immobilization of the skin graft through bolster placement was essential to graft take and survival.…”

“…Primary closure may be attempted with small defects and when advancement of the mucosa does not lead to distortion of the cheek or lip 2. Larger defects, particularly those without exposure of underlying bone, may be considered for a skin graft.…”

“…However, there may be scarring and fibrosis of the graft, and the take rate is less successful when the graft is placed directly on bone 3. In addition, this technique is not typically used in a previously irradiated field 2. Alvi and Meyers4 reported a 25% incidence of osteoradionecrosis (ORN) in patients who underwent skin graft reconstruction of a marginal mandibulectomy with subsequent radiation therapy.…”

“…They have not been widely accepted or utilized. Larger defects involving significant bone excision or subtotal glossectomy or with radiation exposure often require free tissue transfer with a radial forearm free flap or anterolateral thigh flap 2. Although it provides excellent coverage and appropriate tissue bulk, a free flap adds significant operative complexity and time.…”

The Fusion of Craniofacial Reconstruction and Microsurgery

“…Vascularized bone is best used to reconstruct segmented defects of the anterior portion of the mandible to avoid mandibular arch collapse. [60][61][62][63] The two main donor sites for vascularized bone used by our institution for mandibular reconstruction are the fibula and iliac crest. The mainstay of mandibular reconstruction is the free fibula flap, as it has the widest application.…”