Free Flap Reconstruction of Lateral Mandibular Defects: Indications and Outcomes

Abstract

Objective: To evaluate outcomes following lateral mandibular defect free flap reconstruction. Method: Patients undergoing lateral mandibular defect free flap reconstruction from 1999 to 2010 at 2 tertiary care centers were classified into 4 groups based on type of reconstruction: 1) radial forearm swing (n = 8), 2) radial forearm with bar (n = 5), 3) osteocutaneous radial forearm (n = 73) and 4) fibula free flap reconstruction (n = 51). Results: The majority of patients were male (67%) and presented with advanced T-stage (59%) squamous cell carcinoma (93%) involving the alveolus (26%) retromolar trigone (21%) or oral tongue (25%). The recipient site complication rate approached 35% and included infection and mandibular malunion (n = 9), exposed bone or mandibular plates (n = 7), venous congestion (n = 2), and flap failure (n = 6). Most patients demonstrated little to no trismus following reconstruction (81%) and were able to resume a regular or soft diet (61%). No difference in complication rates, hospital stay or postoperative outcomes was seen between osteocutaneous radial forearm and fibula free flap groups ( P > .05). Conclusion: Free flap reconstruction of lateral mandibular defects results in acceptable functional outcomes for the majority of patients including those who undergo osteocutaneous radial forearm free tissue transfer.