AAHS ASPN ASRM - 2013 Annual Meeting - American Association ...

Immediate Free Flap Reconstruction in the Management of Advanced Mandibular Osteoradionecrosis
Institution where the work was prepared: National Taiwan University Hospital, Taipei, Taiwan
Nai-Chen Cheng, MD; Ming-Ting Chen; Hao-Chi Tai; Yueh-Bih Tang; National Taiwan University Hospital
Management of advanced mandibular osteoradionecrosis (ORN) is a difficult and challenging clinical problem. When the patient fails to respond to the conservative
treatments, or has pathological fracture, radical resection of the involved mandible and surrounding soft tissue is necessary. We retrospectively reviewed
13 patients who received immediate free flap reconstruction after radical resection for mandibular ORN from January 1995 to March 2005. All patients were
male who received radiotherapy for head and neck cancer. The mean age at the time of surgery was 53.8 years. Among the reviewed cases, eight fibula flaps
and five iliac crest flaps were employed. All flaps survived except one fibula flap, which was salvaged with a pectoralis major myocutaneous flap. The mean
follow-up time was 5 years and 9 months. Every patient experienced complete resolution of ORN symptoms. No evidence of ORN recurrence was observed,
except one developed new ORN at the contralateral mandible five years after the operation. Satisfactory functional and aesthetic outcomes could be achieved
in all patients. Our experience showed that radical resection and immediate reconstruction with free composite bone flap offers an effective treatment in selected
patients with extensive mandibular ORN.
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