Surgical management of the osteoradionecrotic mandible with free vascularised composite flaps.
Osteoradionecrosis (ORN) of the mandible is a serious sequel to radiotherapy administered for malignant neoplasms of the head and neck. In a retrospective/prospective study, 28 patients with mandibular defects due to ORN were reviewed. Monocortical and bicortical defects as well as pathological fractures were reconstructed by means of a free serratus anterior/rib (n = 8) or a vascularised iliac crest flap (n = 25). All the former survived; a pathological fracture, however, occurred postoperatively in 2 of the patients (25%). Five iliac crests were lost (20%). The remaining bone struts healed well. The donor site morbidity was very low. Clinical and radiological longterm follow-up showed that a very acceptable functional and cosmetic result was achieved in all cases. Progress of ORN was prevented in ca. 90% of all patients. The radiological follow-up was facilitated with the use of high-resolution CT-scans.
Ioannides
C
C
Head and Neck Surgery unit, University Hospitals, Catholic University, Leuven, Belgium.
Fossion
E
E
Boeckx
W
W
Hermans
B
B
Jacobs
D
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods / Q000473:pathology; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D017102:Fracture Healing; D005598:Fractures, Spontaneous / Q000209:etiology / Q000601:surgery; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D008337:Mandibular Fractures / Q000209:etiology / Q000601:surgery; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D010025:Osteoradionecrosis / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000009:adverse effects / Q000379:methods* / Q000473:pathology; D014057:Tomography, X-Ray Computed