DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20172124

Central arch mandibular reconstruction after surgery of oral carcinoma: an observational experience at MDACC, Houston, Texas, USA

Prafulla Kumar Das, Geoffrey L. Robb

Abstract


Background: Reconstruction of head and neck defects in general and oro-mandibular defects in particular, represents a challenge to the head and neck reconstructive surgeon. The most common indication of oro-mandibular reconstruction remains ablative surgery for neoplastic disease of the oral cavity and oropharynx. The principal purpose was evaluation of the various methods of such reconstruction done in order to achieve the best cosmetic and functional outcome in terms of adequate mouth opening, oral competence, deglutition of semisolid to solid foods, speech intelligibility, minimum donor site morbidity and complication.

Methods: The authors presented an observational work on the reconstruction of head and neck cancer after their curative excision, mostly oro-mandibular defects of various sizes ranging from 6cm to 12cm with special reference to the central arch during the first authors fellowship to MD Anderson Cancer Center (MDACC), Texas, where the second author was the supervisor.

Results: The authors reported 24 reconstructions including 10 bony reconstructions. The free flap was preferred to pedicle flap for the reason of better aesthetic and functional outcome. The free fibula was mostly preferred due to its characters akin to the native mandible. Seventy-five patients were also observed in the outpatient clinic and evaluated during the follow up period for aesthetic and functional aspects, donor site morbidity, and long term complications. The first auther also evaluated that the incidence of primary closure with residual cosmetic defect in his study had come down from 28.47% before MDACC visit to only 4.38% today owing to more number of free and pedicle flaps were used.

Conclusions: The free fibula was found to be the best option for mandible reconstruction overall. Observation within high volume centers however limited it may be, certainly upgraded the knowledge and working skills of the second author after he came back to his institution of Acharya Harihar Regional Cancer Center (AHRCC) in India.


Keywords


Central arch mandibulectomy, Free fibula flap, Microvascular technique, Oral cancer

Full Text:

PDF

References


Seikaly H, Chau J, Li F, Driscoll B, Seikaly D. Bone that matches the properties of the mandible. J Otolaryngol. 2003;32(4):262-5.

Okura M, Isomura ET, Lida S, Kogo M. Long term outcome and factors influencing bridging plates for mandibular reconstruction. Oral Oncol. 2005;41:791-8.

Urken ML, Buchbinder D, Costantino PD, Sinha U, Okay D, Lawson W, et al. Oromandibular reconstruction using microvascular composite free flaps. Arch Otolalyngol Head Neck Surg. 1991;117:733-44.

Genden E, Haughey BH. Mandibular reconstruction by vascularized free tissue transfer. Am J Otolaryngol. 1996;17:219-27.

Koch WM, Yoo GH, Goodstein ML, Eisele DW, Richtsmeier WJ, Price JC. Advantages of mandibular reconstruction with the Titanium Hollow Screw Osseointegrating Reconstruction plate (THROP). Laryngoscope. 1994;104:545-52.

Poli T, Ferrari S, Biancha B, Sessena E. Primary oromandibular reconstruction using free flaps and THORP plates in cancer patients: a 5-year experience. Head Neck. 2003;15-23.

Yokoo S, Komori T, Furudoi S, Shibuya Y, Umeda M, Ichinose A, et al. Indications for vascularised free rectus abdominis musculocutaneous flap in oromandibular region in terms of efficiency of anterion rectis sheath. Microsurg. 2003;23:96-102.

Dissa JJ, Cordeir PG. Mandible reconstruction with microvascular surgery. Semin Surg Oncol. 2000;19(3):226-34.

Valentini V, Agrillo A, Batisti A, Gennaro P, Calabrse l, Ianetti G. Surgical planning in reconstruction of mandibular defect with fibula free flap; 15 patients. J Craniofac Surg. 2005;16(4):601-7.

Alan G, Yadranko D, Raghu SA, Travis M, Brian C. Evaluation of fibula free flap donor site morbidity. Am J Otolaryngol. 2006;27(1):29-32.

Bhathena HM. Mandibular reconstruction with local live vascularized bone transfer. Acta Chir Plast. 2004;46376-80.

Santamaria E, Wei FC, Chen HC. Fibula osteoseptocutaneous flap for reconstruction of osteoradionecrosis of the mandible. Plast Reconstruct Surg. 1998;101:921.

Koshima I, Hosoda S, Inagawa K, Urushibara K, Moriguchi T. Free combined anterolateral thigh flap and vascularised fibula for wide, through and through oromandibular defects. J Reconstr Microsurg. 1998;14(8):529-34.

Kessler P, Schultze MS. Lengthening of Reconstructed mandible with pre-fabricated osseous free flaps: A three years experience with 23 patients. Plast Reconstr Surg. 2003;111:1400-6.

Mehta RP, Deschler DG. Mandibular reconstruction in 2004: An analysis of various techniques. Curr Opinion Otolaryngol Head Neck Surg. 2004;12(4):288-93.