The role of sternum in osteomyocutaneous reconstruction of major mandibular defects

Abstract

Replacement of skeletal support after extensive intraoral resection demands the use of a vascularized bone graft. This can be provided by microvascular free transfer using the ilium or metatarsal bones or by using muscle as a vascular carrier, employing the rib, the spine of the scapula, or the clavicle. Over a 5 year period, 27 patients underwent mandibular reconstruction with a vascularized segment of the outer table of sternum transposed together with a skin island on the pectoralis major muscle. Loss of bone occurred in two patients. A 93 percent survival rate was achieved. An earlier, smaller series of six patients using rib for reconstruction resulted in an unacceptably high complication rate. Success in survival of the bone graft, however, is not enough to procure a satisfactory result. Specific aspects of surgical technique are described that create an alveolar ridge with a sulcus on either side that can accept a denture; a diaphragm to replace the floor of the mouth and eliminate dead space; and an esthetically acceptable appearance, with definition of the jawline and a properly supported lower lip.