Microvascular reconstruction of segmental mandibular defects without tracheostomy.
OBJECTIVE
To report our experience with mandibular resection and reconstruction using vascularized bone-containing free flaps without an elective tracheostomy.


METHODS
Case series with chart review.


METHODS
Tertiary referral hospital center.


METHODS
Sixty-six patients undergoing mandibular reconstruction with vascularized bone-containing free flaps without an elective tracheostomy were identified between 1995 and 2013. We describe patient, tumor, and surgical factors and report perioperative outcomes in this population.


RESULTS
Most patients underwent fibula free flap reconstruction (n = 61, 92.44%). The 4 most frequent indications for resection were osteoradionecrosis, parotid carcinoma, oral squamous cell carcinoma, and osteomyelitis. Bone defects ranging from 4.0 to 13.0 cm were reconstructed, and associated soft-tissue defects were reconstructed with skin paddle sizes ranging from 24.0 to 450.0 cm(2). There was only 1 patient with a bilateral central mandibular defect, and there were no tongue/pharyngeal soft-tissue defects or bilateral neck dissections. One case required emergent tracheostomy on postoperative day 1, and 2 more patients developed respiratory complications. There were no cases of perioperative death or flap failure.


CONCLUSIONS
Mandibular free flap reconstruction is feasible without an elective tracheostomy in a subset of carefully selected patients without bilateral central mandibular defects, tongue/pharynx defects, or bilateral neck dissection.
Division of Otolaryngology-Head and Neck Surgery, Université de Montréal, Montreal, Canada sp.moubayed@gmail.com.
Sami P
SP
Moubayed
Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Daniel A
DA
Barker
Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Ali
A
Razfar
Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Vishad
V
Nabili
Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Keith E
KE
Blackwell
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation; D005260:Female; D006801:Humans; D008297:Male; D008339:Mandibular Neoplasms / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D014139:Tracheostomy; D016896:Treatment Outcome
complications; free flap; mandibular reconstruction; tracheostomy