Reconstruction of the lateral mandibulectomy defect: management based on prognosis and location and volume of soft tissue resection.
OBJECTIVE
To examine how the accompanying soft tissue resection of the oral cavity, oropharynx, neck, or face affects the reconstructive management of the lateral mandibulectomy defect.


METHODS
Retrospective review of 76 consecutive patients.


METHODS
Patient and tumor variables were extracted from the medical records. Outcomes that were examined included method of reconstruction, medical complications, flap complications, and survival.


RESULTS
Age greater than 70 years (P = .03), moderate or severe comorbidity (P = .01), and tumor involvement of the base of tongue (P = .03) were significantly associated with decreased use of a free flap and with decreased 3-year survival rates. For choice of free (osteocutaneous radial forearm free flap or fibula vs. rectus abdominis) and regional flaps (pectoralis or cervicodeltopectoral), lateral defects could be classified into one of three types: type 1 (n = 60), lateral defect with a soft tissue resection limited to the oral cavity and oropharynx; type 2 (n = 11), lateral defect with a through and through defect of the lower one third of the face (skin overlying the mandible) or neck; and type 3 (n = 5), lateral defect with an associated large-volume resection of the midface, parotid, or cheek skin.


CONCLUSIONS
When the lateral mandible is resected with an accompanying large soft tissue defect of the neck or face (type 2 or type 3 defect), the reconstructive challenge becomes the determination of how best to cover the planned bony reconstruction or whether to perform only a soft tissue reconstruction. When placed in the context of expected prognosis, the proposed classification system based on the location and volume of the associated soft tissue resection can help guide the reconstructive options for these decisions.
Deleyiannis
Frederic W-B
FW
Division of Plastic and Reconstructive Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. deleyiannisfw@msx.upmc.edu
Rogers
Carolyn
C
Lee
Edward
E
Russavage
James
J
Gastman
Brian
B
Dunklebarger
Joshua
J
Lai
Stephen
S
Ferris
Robert
R
Myers
Eugene N
EN
Johnson
Jonas
J
D000368:Aged; D001860:Bone Plates; D015897:Comorbidity; D005260:Female; D005927:Glossectomy; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000601:surgery*; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000379:methods*; D011379:Prognosis; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps