title: Simultaneous vascularized bony reconstruction of the maxilla and mandible using a single fibula: A case report.
abstract: Simultaneous maxillary and mandibular reconstruction is exceedingly rare. These are complicated cases, requiring consideration of multiple variables: defect components, donor site morbidity, recipient vessels, and so forth. We describe a unique case of secondary maxillary/mandibular reconstruction in a 59-year-old male. The original defect was created after removal of a buccal squamous cell carcinoma, involving the external cheek skin, buccal mucosa, right mandibular body, and right inferior maxilla; a free vertical rectus abdominis musculocutaneous flap was used for the initial reconstruction. At the time of presentation to our clinic, the patient was tube-feed-dependent, unable to speak, and distressed regarding his appearance. We revised his reconstruction, rebuilding his maxilla and hemimandible using two free fibula flaps from a single fibula. The fibulae were vascularized via vein grafts and an ALT flap was used for external cheek resurfacing. All flaps survived and there were no complications at seven months since his surgery (when this report was written). The patient had intelligible speech and maintained adequate nutrition with a soft diet. Simultaneous vascularized bony reconstruction of the maxilla and mandible using a single fibula flap may be performed safely and with good outcomes.
authors.affiliation: Department of Plastic Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Alexander F
authors.initials: AF
authors.lastname: Mericli
authors.affiliation: Department of Plastic Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Friedstat
authors.affiliation: Department of Plastic Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Edward I
authors.initials: EI
authors.lastname: Chang
authors.affiliation: Department of Plastic Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Hanasono
mesh_terms: D016025:Bone Transplantation / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D002610:Cheek / Q000473:pathology / Q000601:surgery; D005360:Fibula / Q000601:surgery / Q000637:transplantation*; D006801:Humans; D008297:Male; D008334:Mandible / Q000473:pathology / Q000601:surgery; D008437:Maxilla / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery*; D064827:Myocutaneous Flap / Q000098:blood supply / Q000637:transplantation*; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging / Q000379:methods; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function / Q000502:physiology; D018570:Risk Assessment; D014945:Wound Healing / Q000502:physiology
keywords: CAD/CAM; fibula; mandible; maxilla; secondary head and neck reconstruction