Abstract
Heterotopic ossification (HO) is one of the described phenomena after maxillofacial reconstructive surgery using fibular free flap (FFF) at the reception-site. The aim of this study was to determine the radiological incidence and form of HO along the fibular vascular pedicle as well as the rate of clinical symptoms if present. CT-scans of 102 patients who underwent jaw reconstructive surgery by using FFF from January 2005 to December 2019 were evaluated concerning the presence of HO. Subsequently, the patient files were evaluated to identify the cases with clinical signs and complications related to the presence of HO. A radiological classification of four different HO types was developed. Out of 102 patients, 29 (28.43%) presented radiological findings of HO. Clinical symptoms were recorded in 10 cases (9.8%) (dysphagia (n = 5), trismus (n = 3), bony masses (n = 2)) and from these only five (4.9%) needed surgical removal of calcified structures. HO occurs significantly in younger patients (mean 52.3 year). In maxillary reconstructions, HO was radiologically visible six months earlier than after mandibular reconstruction. Furthermore, HO is observed after every third maxilla and every fourth mandible reconstruction. This study developed for the first time a classification of four distinct HO patterns. HO types 1 and 2 were mostly observed after mandible reconstruction and type 4 predominantly after maxilla reconstruction.
Highlights
IntroductionThe fibular free flap (FFF) is the workhorse of defect-oriented reconstruction after combined hard and soft tissue resections within the maxillofacial region [1]
Chi-square-test was used to compare the frequency of heterotopic ossification (HO) in males and females
Comparing time of detection of HO after maxillary and mandibular reconstruction, it is noticeable that maxillary HO occurred six months earlier than mandibular HO (Figure 4)
Summary
The fibular free flap (FFF) is the workhorse of defect-oriented reconstruction after combined hard and soft tissue resections within the maxillofacial region [1]. The available bone length is usually sufficient for reconstruction of the lower jaw up to class IV [3], offering the possibility of satisfactory oral rehabilitation using endosseous dental implants [4,5,6]. FFF provides a vascular pedicle of sufficient length for use in the entire head and neck region between forehead and clavicula [7] and shows an overall low donor site morbidity [8]. There is the option of forming one or more septo-cutaneous skin paddles, which are suitable for flap monitoring as well as for closing soft tissue defects of the head and neck region
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