Pedicled partial thickness clavicular graft for oromandibular reconstruction

Abstract

To report our experience on pedicled partial-thickness clavicular graft (PPCG) for oromandibular reconstruction. PPCG was used for oromandibular reconstruction after tumor resection in 23 patients with early-stage gingival carcinoma but were eager for postoperative dental implant therapy for restoration of good occlusal function. PPCG was harvested during neck dissection. The sternocleidomastoid (SCM) myocutaneous flap was also harvested in 18 cases. Dental implants were placed in the clavicular graft of 19 cases, and the other 4 declined because of financial concerns. Postoperative viability of the flaps and the dental implants were assessed. All the clavicular grafts survived without necrosis and implant-supported dentures of 19 patients provided satisfactory occlusion and masticatory function. Complications, although low in occurrence, included partial skin pedicle loss, nonunion between the clavicular graft and the remaining inferior border of the mandible, and clavicular bone fracture. PPCG is a simple but reliable procedure for reconstruction of severe alveolar defects. Correct preoperative evaluation and precise surgical technique contribute to higher success rates and lower complication rates. It is a viable reconstructive option for early-stage gingival carcinoma requiring neck dissection without postoperative radiation therapy.