Immediate Free Flap Reconstruction in the Management of Advanced Mandibular Osteoradionecrosis

Abstract

Management of advanced mandibular osteoradionecrosis (ORN) is a difficult and challenging clinical problem. When the patient fails to respond to the conservative treatment, 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 within the past ten years. All patients were male who received radiotherapy for head and neck cancer. The mean age 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 4 years and 9 months (range, 3 months to 10 years). 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 patients with extensive mandibular ORN.