Osseous Reconstruction Following Treatment of Head and Neck Tumors

Abstract

Summary The cancer-ablated patient presents a great challenge to the reconstructive process. Surgical scarring and fibrosis, compromise of regional perfusion, communication and contamination between the mouth and surgical wound, and the effects of therapeutic radiation on the hard and soft tissues all must be considered. Of course, the patient poses the most important challenges and often raises essential questions: What will I look like? Will I be able to talk? To eat? To breathe? Will I be in pain? Will I be able to return to work? How long will I be in the hospital? Will I live? Patience and honesty must be provided when addressing these issues with the patient and family. When asked to write this clinical article, we agreed because it gave us the opportunity to share our approach to these difficult issues. Ours is not the only approach to reconstructive jaw surgery, but in our hands the combination of wide excision of the involved tissues, delayed or immediate reconstruction with a free flap of hard and soft tissue, and if possible the establishment of a fixed osteodental unit is the approach of choice. We leave the use of particulate grafting to others more experienced in these areas. The reconstruction and rehabilitation of the patient with head and neck malignancy remain among the greatest challenges for surgeons working in this anatomic region. The obvious devastating effects on socialization, communication, nutritional maintenance, and respiration created by cancer ablation make it clear that control of disease alone is no longer an acceptable treatment goal. Furthermore the awesome tasks posed by head and neck malignancy require true cooperation by many disciplines of medicine and dentistry. The oral and maxillofacial surgeon often is pivotal in this interaction.