title: Osteocutaneous free tissue transplantation for mandibular osteoradionecrosis.
abstract: OBJECTIVE
  To describe the success rate, complications, and functional outcomes of patients who are treated with osteocutaneous free tissue transplantation for grade 4 mandibular osteoradionecrosis (ORN).
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Tertiary care academic medical center.
  
  
  METHODS
  Twelve patients (8 males, 4 females; mean age, 57.6 years) with grade 4 mandibular ORN. Three patients (25%) had a history of primary radiotherapy, two (17%) had previous concurrent chemoradiation, and seven (58%) had undergone postoperative adjuvant radiotherapy. Ten patients (83%) had previous major ablative surgery to treat the primary tumor and five (50%) had been reconstructed with a free tissue transplant prior to the onset of ORN.
  
  
  METHODS
  All patients underwent reconstruction with an osteocutaneous free tissue transplant for grade 4 mandibular ORN between 1999 and 2006.
  
  
  METHODS
  Successful treatment of mandibular ORN; major, minor, and late complications; gastrostomy tube (G-tube) dependence; speech and swallowing scores.
  
  
  RESULTS
  Grade 4 mandibular ORN was successfully treated in eight (73%) evaluable patients. One patient (8%) died of a second primary tumor before the 12-month assessment. Eight patients (67%) had a major complication, three (25%) had a minor complication, and nine (75%) had a late complication. Three of the five G-tube- dependent patients prior to mandibular reconstruction were able to discontinue the use of their G-tube. Seven of the eight successfully treated patients maintained their nutrition by mouth. Median "range of liquids" score was 6/6 (range, 4 to 6). Median "range of solids" score was 4/6 (range, 3 to 6). Median "understandability of speech" score was 4/5 (range, 2 to 5).
  
  
  CONCLUSIONS
  Grade 4 mandibular ORN was treated successfully with an osteocutaneous free tissue transfer in eight evaluable patients (73%). In successfully treated patients, median speech/swallowing scores were highly functional, but the remaining radiated soft tissue resulted in higher local wound complications and a modified diet.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan 48109-0312, USA.
authors.forename: Shamir P
authors.initials: SP
authors.lastname: Chandarana
authors.forename: Eric J P
authors.initials: EJ
authors.lastname: Chanowski
authors.forename: Keith A
authors.initials: KA
authors.lastname: Casper
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Wolf
authors.forename: Carol R
authors.initials: CR
authors.lastname: Bradford
authors.forename: Francis P
authors.initials: FP
authors.lastname: Worden
authors.forename: Avraham
authors.initials: A
authors.lastname: Eisbruch
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Chepeha
mesh_terms: D003680:Deglutition Disorders / Q000453:epidemiology / Q000209:etiology; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply; D005774:Gastrostomy / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D008336:Mandibular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D010025:Osteoradionecrosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013064:Speech Disorders / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome