title: Fibular free flap reconstruction for the management of advanced bilateral mandibular osteoradionecrosis.
abstract: Fibular osteoseptocutaneous flap has been widely used for unilateral mandibular reconstruction. However, reports about the effects of fibular osteoseptocutaneous flap for the reconstruction of bilateral mandibular defects are limited. In this study, we used free vascularized fibular flaps to successfully manage bilateral mandibular osteoradionecrosis(ORN) in 5 patients. Functional aspects were evaluated during the reconstruction process. All 5 patients had bilateral refractory ORN of the mandible and underwent radical resection between 2003 and 2011. The reconstruction surgery was performed in 2 stages using 2 free fibular flaps in 3 patients. In the other 2 patients, reconstruction was performed in a single stage using 2 separate flaps prepared from a single fibula. All patients had a healthy mandibular symphysis and meniscus of the temporomandibular joint, and these structures were preserved during the reconstruction.Of the 10 defects involving the mandible sides, 9 were successfully reconstructed. One microvascular composite flap failed because of radiation injury to the arterial endothelium at the recipient site. After the treatments, all patients had good esthetic and functional outcomes. Preoperative clinical features such as trismus and dysphagia were also markedly improved. Our surgical method may be an effective alternative for the clinical management of advanced bilateral mandibular ORN.
authors: From the *Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, and †Department of Oral Diseases, Peking University Third Hospital, Beijing, People's Republic of China.
authors: Xiao-Feng
authors: XF
authors: Shan
authors: Ru-Huang
authors: RH
authors: Li
authors: Xu-Guang
authors: XG
authors: Lu
authors: Zhi-Gang
authors: ZG
authors: Cai
authors: Jie
authors: J
authors: Zhang
authors: Jian-Guo
authors: JG
authors: Zhang
mesh_terms: D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D003680:Deglutition Disorders / Q000601:surgery; D004435:Eating / Q000502:physiology; D004954:Esthetics; D005260:Female; D005360:Fibula / Q000601:surgery; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000601:surgery*; D008875:Middle Aged; D010025:Osteoradionecrosis / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D016038:Skin Transplantation / Q000379:methods*; D013060:Speech / Q000502:physiology; D060053:Transplant Donor Site / Q000601:surgery; D016896:Treatment Outcome; D014313:Trismus / Q000601:surgery