1
|
Chauvel-Picard J, Kreutzer K, Heiland M, Kreusch T, Ebker T, Beck-Broichsitter B. One stage microvascular mandible reconstruction by using scapula chimeric flap combined with computer-aided-design and computer-aided-manufacturing plate including bilateral alloplastic TMJ prosthesis: A case report. Microsurgery 2020; 41:263-269. [PMID: 33103294 DOI: 10.1002/micr.30669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 06/01/2020] [Accepted: 10/02/2020] [Indexed: 11/12/2022]
Abstract
This report focuses a defect comprising the complete mandible due to osteonecrosis, including both condyles, that required bilateral temporomandibular joint (TMJ) reconstruction with complete mandibular corpus using a computer-aided-design and computer-aided-manufacturing(CAD-CAM) planning to harvest a scapula chimeric free flap combined with plate including bilateral alloplastic TMJ prosthesis. This procedure was realized in one and the same surgery. A 73 year-old-man developed an osteoradionecrosis of the total mandible including both condyles after radiation therapy for a squamous cell carcinoma of the tongue base(cT4aN2bM0G3). A CAD-CAM reconstruction was planned with a plate extended by bilateral individual TMJ prosthesis, individual fossa components and combined with a composite free flap originating from the subscapular vessel system including scapula(circumflex subscapular artery) for reconstruction of the mandibular corpus which was osteotomized in three segments with a resection guide, the parascapular skin paddle (descending branch of circumflex subscapular artery) for compensation of the soft tissue deficiency of the cervical skin and latissimus dorsi muscle(thoracodorsal artery) for the inner mucosal lining and intraoral reconstruction. The subscapular artery was anastomosed to the external carotid artery and two concomitant veins were sutured end-to-side to the internal jugular vein. The patient was discharged without feeding tube and tracheostomy. No complications have been observed after 6 months follow-up. The patient was able to tolerate soft diet and had comprehensible speech. Thus, a total mandibular reconstruction including both condyles using alloplastic and autoplastic reconstruction in one and the same stage is a valid option and may be considered in comparably severe cases.
Collapse
Affiliation(s)
- Julie Chauvel-Picard
- Department of Oral and Craniomaxillofacial Surgery, Centre Hospitalo-Universitaire Nord, Saint-Etienne, France.,Jean Monnet University, Saint-Etienne, France
| | - Kilian Kreutzer
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Kreusch
- Department of Oral and Maxillofacial Plastic Surgery and Dentistry, Head and Neck Center, Hamburg, Germany
| | - Tobias Ebker
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | |
Collapse
|
2
|
Computer-assisted resection and reconstruction of bilateral osteoradionecrosis of the mandible using 2 separate flaps prepared from a single fibula. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:102-106. [PMID: 29627200 DOI: 10.1016/j.oooo.2018.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 01/06/2018] [Accepted: 02/25/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Osteoradionecrosis of the mandible is a late radiation-induced complication, which is a major concern in survivors of head and neck cancer. STUDY DESIGN In this study, we present a case of a patient with nasopharyngeal carcinoma who developed extensive bilateral osteoradionecrosis of the ascending ramus of the mandible. After preoperative virtual surgical planning, the obtained data were used to fabricate patient-specific cutting templates. The bilateral mandibular defects were reconstructed using 2 separate flaps prepared from a single fibula. RESULTS Both defects were successfully reconstructed, and satisfactory aesthetic and functional results were achieved. CONCLUSIONS Bilateral mandibular osteoradionecrosis can be managed with virtual surgical planning, and the defects can be reconstructed using 2 separate flaps prepared from a single fibula.
Collapse
|
3
|
Surgical management of severe osteoradionecrosis of the mandibular bone by using double free flap reconstruction. J Craniomaxillofac Surg 2018; 46:148-154. [DOI: 10.1016/j.jcms.2017.09.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/11/2017] [Accepted: 09/25/2017] [Indexed: 11/24/2022] Open
|
4
|
Fibular free flap reconstruction for the management of advanced bilateral mandibular osteoradionecrosis. J Craniofac Surg 2015; 26:e172-5. [PMID: 25675011 DOI: 10.1097/scs.0000000000001391] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Fibular osteoseptocutaneous flap has been widely used for unilateral mandibular reconstruction. However, reports about the effects of fibular osteoseptocutaneous flap for the reconstruction of bilateral mandibular defects are limited. In this study, we used free vascularized fibular flaps to successfully manage bilateral mandibular osteoradionecrosis(ORN) in 5 patients. Functional aspects were evaluated during the reconstruction process. All 5 patients had bilateral refractory ORN of the mandible and underwent radical resection between 2003 and 2011. The reconstruction surgery was performed in 2 stages using 2 free fibular flaps in 3 patients. In the other 2 patients, reconstruction was performed in a single stage using 2 separate flaps prepared from a single fibula. All patients had a healthy mandibular symphysis and meniscus of the temporomandibular joint, and these structures were preserved during the reconstruction.Of the 10 defects involving the mandible sides, 9 were successfully reconstructed. One microvascular composite flap failed because of radiation injury to the arterial endothelium at the recipient site. After the treatments, all patients had good esthetic and functional outcomes. Preoperative clinical features such as trismus and dysphagia were also markedly improved. Our surgical method may be an effective alternative for the clinical management of advanced bilateral mandibular ORN.
Collapse
|
5
|
Weitz J, Kreutzer K, Bauer FJM, Wolff KD, Nobis CP, Kesting MR. Sandwich flaps as a feasible solution for the management of huge mandibular composite tissue defects. J Craniomaxillofac Surg 2015; 43:1769-75. [PMID: 26330301 DOI: 10.1016/j.jcms.2015.07.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/24/2015] [Accepted: 07/31/2015] [Indexed: 10/23/2022] Open
Abstract
In the current therapy of head and neck defects, surgical reconstruction with the aid of pedicle or free flaps is common practice. Suitable single flaps are available to solve most reconstructive challenges. However, reconstruction can become a problem in extensive mandibular defects, as they are often caused by large primary tumors or osteoradionecrosis. These composite defects often lead to large intraoral or extraoral fistulas due to the involvement of mucosa, skin, mandible and soft tissue. These issues call for a double flap approach in order to achieve adequate reconstruction. Therefore, we developed a surgical sandwich technique as presented in this study. The procedure features the acquisition and use of two vascular flaps which can be freely combined according to their desired features (for example being of high tissue volume or osteomyocutaneous). In our study we included 11 patients (ten male, one female) with a mean age of 57 years. Seven of the patients had defects due to osteoradionecrosis and four due to tumor resection. A sandwich technique was performed in a single operation in eight patients, whereas for three patients several operations were necessary. The flaps used included: fibula free flap (FFF); anterolateral thigh (ALT); radial forearm flap (RFF); deltopectoral flap (DPF) and tensor fascia lata (TFL). The following combinations were used: FFF and ALT (three cases), FFF and RFF (two), FFF and DPF (three), ALT and TFL (two), and two ALT flaps (one). The sandwich technique proved suitable for complex reconstructions and led to desirable esthetic and functional results. The flexibility in combining different free or pedicle flaps made it possible to address various defect situations and consequently offer satisfactory surgical reconstruction for complex cases.
Collapse
Affiliation(s)
- J Weitz
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Ismaninger Str. 22, D-81675 Munich, Germany.
| | - K Kreutzer
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Ismaninger Str. 22, D-81675 Munich, Germany
| | - F J M Bauer
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Ismaninger Str. 22, D-81675 Munich, Germany
| | - K-D Wolff
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Ismaninger Str. 22, D-81675 Munich, Germany
| | - C-P Nobis
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Ismaninger Str. 22, D-81675 Munich, Germany
| | - M R Kesting
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Ismaninger Str. 22, D-81675 Munich, Germany
| |
Collapse
|
6
|
Fan S, Wang YY, Lin ZY, Zhang DM, Yu X, Chen WX, Zhong JL, Li QX, Feng YH, Chen WL, Pan CB, Dias-Ribeiro E, Sonoda CK, Ye JT, Li JS. Synchronous reconstruction of bilateral osteoradionecrosis of the mandible using a single fibular osteocutaneous flap in patients with nasopharyngeal carcinoma. Head Neck 2015; 38 Suppl 1:E607-12. [PMID: 25783596 DOI: 10.1002/hed.24049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The reconstruction of bilateral osteoradionecrosis (ORN) of mandibular defects using a single free bone flap is rarely performed because extensively radiated neck tissue with severe fibrosis is usually unsuitable for vascularized reconstruction. METHODS Thirty-one patients with nasopharyngeal carcinoma (NPC) underwent bilateral reconstruction of advanced ORN in the mandible using a single fibular osteocutaneous flap. Clinical factors associated with the operation were assessed, including classification of mandible defects, types of recipient vessels, perioperative complications, and postoperative outcomes. RESULTS All of the fibular osteocutaneous flaps survived completely, with the exception of 1 inner skin paddle that presented partial necrosis in a reconstruction of through-and-through defects. All patients experienced an improvement in cosmetic results 6 months after the reconstruction, whereas 23 patients experienced improved mouth opening compared to the preoperative condition. CONCLUSION Advanced bilateral ORN in patients with NPC could be synchronously reconstructed with a single fibular osteocutaneous flap. © 2015 Wiley Periodicals, Inc. Head Neck 38: E-E, 2016.
Collapse
Affiliation(s)
- Song Fan
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - You-Yuan Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhao-Yu Lin
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Da-Ming Zhang
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xin Yu
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wei-Xiong Chen
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jiang-Long Zhong
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qun-Xing Li
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yu-Huan Feng
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wei-Liang Chen
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Chao-Bin Pan
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Eduardo Dias-Ribeiro
- Department of Oral and Maxillofacial Surgery, Dental School of Araçatuba, Universidade Estadual Paulista (UNESP), Araçatuba, São Paulo, Brazil
| | - Celso Koogi Sonoda
- Department of Oral and Maxillofacial Surgery, Dental School of Araçatuba, Universidade Estadual Paulista (UNESP), Araçatuba, São Paulo, Brazil
| | - Jian-Tao Ye
- Department of Prosthodontics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jin-Song Li
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
7
|
Asynchronous Osteoradionecrosis of the Mandible Treated With Sequential Fibula Osteoseptocutaneous Flaps. Ann Plast Surg 2012; 69:283-7. [DOI: 10.1097/sap.0b013e318228e396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
|
9
|
Indications and Outcomes for Mandibular Reconstruction Using Sequential Bilateral Fibula Flaps. Plast Reconstr Surg 2010; 126:1539-1547. [DOI: 10.1097/prs.0b013e3181ef8c86] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
Martín LP, Gallo LJA, Pons MC, Soto MJM, Carretero JLC, García MB. Mandibular osteoradionecrosis: use of sequential fibula free flaps for a remote sequence of complications. Craniomaxillofac Trauma Reconstr 2010; 3:91-5. [PMID: 22110822 DOI: 10.1055/s-0030-1254380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Mandibular osteoradionecrosis is a serious complication of radiotherapy that often leads to severe facial deformity, intolerable pain, fracture, sequestration of devitalized bone and fistulas. The prophylaxis of this severe complication is a major goal in modern combined tumor therapy, but once the pathology is established, conservative treatment modalities are used in almost all patients in an effort to control progression. Radical surgery should only be instituted when conservative methods fail or when severe bone and soft-tissue necrosis prevails. Pathologic fractures and chronic fistulae are clear indicators for radical surgical management. This paper document a case report of severe bilateral mandibular osteoradionecrosis reconstructed with two sequencial osteocutaneous fibular free flap. The authors discuss the different alternatives of treatment and the most important steps for a successful management of this challenge.
Collapse
Affiliation(s)
- L Pingarrón Martín
- Department of Oral and Maxillofacial Surgery, La Paz University Hospital, Madrid, Spain
| | | | | | | | | | | |
Collapse
|
11
|
Harnessing the Potential of the Free Fibula Osteoseptocutaneous Flap in Mandible Reconstruction. Plast Reconstr Surg 2010; 125:305-314. [DOI: 10.1097/prs.0b013e3181c2bb9d] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
12
|
Chang YM, Tsai CY, Wei FC. One-Stage, Double-Barrel Fibula Osteoseptocutaneous Flap and Immediate Dental Implants for Functional and Aesthetic Reconstruction of Segmental Mandibular Defects. Plast Reconstr Surg 2008; 122:143-145. [DOI: 10.1097/prs.0b013e3181774135] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
13
|
Jones NF, Taub PJ. Sequential Second Free Bone Flaps for Reconstruction of Metachronous Mandibular Defects. Plast Reconstr Surg 2005; 116:939-45; discussion 946-8. [PMID: 16163074 DOI: 10.1097/01.prs.0000178041.64335.52] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The purpose of this study was to identify patients who had previously undergone composite resection of a primary carcinoma of the oral cavity and immediate mandibular reconstruction with an osteocutaneous free flap and subsequently developed a local recurrence or a second metachronous tumor that required a second composite resection and immediate mandibular reconstruction with a second osteocutaneous free flap, in order to evaluate bone-to-bone healing of the two vascularized bone grafts and the long-term survival of these patients. METHODS Five patients who had undergone composite resection of a primary carcinoma of the oral cavity subsequently developed a local recurrence or a second metachronous tumor and therefore underwent mandibular reconstruction with two sequential osteocutaneous free flaps. Two sequential fibular osteocutaneous flaps were performed in three patients, two sequential radial forearm osteocutaneous flaps in one patient, and a scapular osteocutaneous flap followed by a radial forearm osteocutaneous flap in one patient. End-to-end osteosynthesis of the second free vascularized bone graft to the first free vascularized bone graft was achieved using mandibular reconstruction plates, miniplates, or compression screws. RESULTS All five patients achieved solid bone-to-bone healing of the second free vascularized bone graft to the first free vascularized graft. Despite two patients only surviving 4 months after the second mandibular reconstruction, one patient survived for 1 year and 8 months and two patients remain disease-free after more than 3 years. CONCLUSION Stable bone-to-bone union of a second osteocutaneous free flap to a previous osteocutaneous free flap mandibular reconstruction improves the quality of life of those patients who require a second composite mandibular resection for the treatment of a local recurrence or a metachronous tumor, but it is probably only palliative.
Collapse
Affiliation(s)
- Neil F Jones
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, California, USA.
| | | |
Collapse
|
14
|
Abstract
OBJECTIVE To analyze the morbidity of a second fibular free tissue transfer when necessary in rare instances when the initial fibular flap fails. CASE DESIGN: Retrospective analysis of a case series. METHODS A database of patients who underwent resection of head and neck malignancies with resultant free flap reconstruction was analyzed retrospectively. All patients undergoing fibular free flaps were studied, and those needing a second fibular osteocutaneous flap were identified. The morbidity from the second flap was evaluated by a standard questionnaire. RESULTS Seven patients underwent a second fibular osteocutaneous flaps for reconstruction; data were available from six. The indications for the second flap were perioperative flap loss (5 patients), osteoradionecrosis (1), and recurrent tumor (1). Follow-up began at 3 months; mean follow-up was 44 (range 9-67) months. The morbidity of harvesting a second fibular flap was similar to that of a unilateral harvest. Four of six patients rated their overall morbidity as low; one patient indicated an intermediate morbidity, and one patient rated their morbidity from the procedure as major. The only donor site morbidities were episodes of mild cellulitis that resolved with outpatient antibiotics. CONCLUSION Harvest of a second fibular osteocutaneous is a reasonable option for reconstruction when a second flap becomes needed. The morbidities are comparable with those encountered with a unilateral fibular flap harvest.
Collapse
Affiliation(s)
- Bobak A Ghaheri
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon 97239, USA
| | | | | |
Collapse
|
15
|
Erdmann D, Giessler GA, Bergquist GEO, Bruno W, Young H, Heitmann C, Levin LS. [Free fibula transfer. Analysis of 76 consecutive microsurgical procedures and review of the literature]. Chirurg 2004; 75:799-809. [PMID: 15138656 DOI: 10.1007/s00104-004-0833-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Since its introduction by Taylor in 1975, microvascular free fibula transfer has become the gold standard in osseous reconstructions requiring vascularized bone transfer. Various modifications of the free fibula have been described in the literature. We reviewed a series of 76 free vascularized fibula transfers during a 7-year period. Data was retrospectively analyzed with respect to type of procedure and outcome, general surgical complications, and flap-related (specific) complications. Of all 76 free fibula flaps, 47 cases healed uneventfully (62%). Interestingly, 53% of all extremity reconstruction cases had at least one of the above complications, whereas in maxillofacial cases the complication rate was only 25%. Complete osseous consolidation at the time of evaluation was confirmed in 58 patients (76%). Complete flap failure occurred in four patients (5%). The complication rates reflect the complexity of the procedures and appear strongly related to the underlying disease and predisposing medical risk factors. Time will tell if advances, e.g., in the field of tissue engineering, will eventually replace autologous vascularized bone transfer.
Collapse
Affiliation(s)
- D Erdmann
- Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
| | | | | | | | | | | | | |
Collapse
|
16
|
Okumuş A, Ozkan AC, Emekli U. Single-stage reconstruction of complex mandibular bone and soft-tissue defects by midsegment ostectomy in osseoseptocutaneous free fibular flap. Plast Reconstr Surg 2002; 110:1803-4; author reply 1804-5. [PMID: 12447073 DOI: 10.1097/00006534-200212000-00034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|