title: Immediate Microsurgical Bone and Nerve Reconstruction in the Irradiated Patient: A Case Report.
abstract: Microsurgical reconstructive techniques have revolutionized the treatment of large head and neck defects. These defects were once forever life altering because of the considerable morbidity to both the form and function of the patient. As time has progressed, microsurgical technique has improved dramatically and has become institutionalized in our training programs. Free flap outcomes in head and neck reconstruction have improved dramatically, and optimization of these outcomes is now key. One overlooked area has been neurosensory reconstruction. In our practice we have focused on this detail, which has proved to be quite important to the patient. This case report details one such case in which a mandibular resection was performed to treat osteoradionecrosis. We, as the reconstructive team, elected to perform a double-barrel fibular free flap procedure with simultaneous inferior alveolar nerve reconstruction using a 70-cm processed nerve allograft. Normal neurosensory function returned in this patient. As the state of the art advances with continued successful osseous and soft tissue reconstruction in the head and neck, we propose concomitant neurosensory functional reconstruction always be considered.
authors.affiliation: Assistant Professor of Surgery, Division of Oral and Maxillofacial Surgery, Miller School of Medicine, University of Miami, Miami, FL.
authors.forename: Ramzey
authors.initials: R
authors.lastname: Tursun
authors.affiliation: Assistant Professor of Surgery, Division of Oral and Maxillofacial Surgery, Miller School of Medicine, University of Miami, Miami, FL; Associate Program Director, Division of Oral and Maxillofacial Surgery, Naval Medical Center Portsmouth, Portsmouth, VA; and Assistant Professor of Surgery, Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD. Electronic address: DrG@jmgiii.com.
authors.forename: J Marshall
authors.initials: JM
authors.lastname: Green
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy; D003131:Combined Modality Therapy; D005360:Fibula / Q000637:transplantation*; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008334:Mandible / Q000528:radiation effects / Q000601:surgery; D008340:Mandibular Nerve / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D016067:Nerve Transfer / Q000379:methods*; D010025:Osteoradionecrosis / Q000175:diagnosis* / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D014062:Tongue Neoplasms / Q000532:radiotherapy