Free flap reconstruction of lateral mandibular defects: indications and outcomes

Otolaryngol Head Neck Surg. 2012 Apr;146(4):547-52. doi: 10.1177/0194599811430897. Epub 2011 Dec 12.

Abstract

Objective: To compare outcomes following osteocutaneous radial forearm and fibula free flap reconstruction of lateral mandibular defects.

Study design: Retrospective case-controlled study.

Setting: Historical cohort study.

Subjects and methods: All patients who underwent free flap reconstruction of lateral mandibular defects from 1999 to 2010 were included in this study. Patients were classified into 2 groups based on type of reconstruction: (1) osteocutaneous radial forearm (n = 73) and (2) fibula free flap reconstruction (n = 51). Patient characteristics, length of hospital stay, recipient and donor site complications, and long-term outcomes including postoperative diet were evaluated.

Results: Most patients were male (68%) and presented with advanced T-stage (71%) squamous cell carcinoma (94%) involving the alveolus (21%), retromolar trigone (23%), or oral tongue (21%). Median length of hospital stay was 8 days (range, 4-22 days). The recipient site complication rate approached 27% and included infection (n = 11), mandibular malunion (n = 9), exposed bone or mandibular plates (n = 9), and flap failure (n = 5). Most patients demonstrated little to no trismus following reconstruction (94%) and were able to resume a regular or edentulous diet (73%). No difference in complication rates or postoperative outcomes was seen between osteocutaneous radial forearm and fibula free flap groups (P > .05). One patient underwent dental implantation following osteocutaneous radial forearm free flap reconstruction. No patients from the fibula free flap group underwent dental implantation.

Conclusion: The osteocutaneous radial forearm and fibula free flap provide equivalent wound healing and functional outcomes in patients undergoing lateral mandibular defect reconstruction.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / surgery*
  • Case-Control Studies
  • Female
  • Fibula / transplantation
  • Free Tissue Flaps*
  • Humans
  • Length of Stay
  • Male
  • Mandibular Neoplasms / surgery*
  • Middle Aged
  • Oral Surgical Procedures / methods*
  • Postoperative Complications
  • Radius / transplantation
  • Reconstructive Surgical Procedures / methods*
  • Retrospective Studies
  • Survival Rate
  • Tongue Neoplasms / surgery*
  • Treatment Outcome