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[Mandibular osteoradionecrosis. Part II: efficiency of revascularization surgery]
C d'Hauthuille1, S Testelin, C Moure
1Service de chirurgie maxillofaciale et stomatologie, CHU de Nantes, place Alexis-Ricordeau, 44000 Nantes, France. Cedric@dhauthuille.net
Introduction:
The physiopathology of osteoradionecrosis (ORN) is linked to vascular and cellular aspects of bone physiology. The authors had for aim to check whether the transposition of non-irradiated tissues could repair vascular and bone lesions.
Material And Method:
A retrospective study was made from 1992 to 2002 on all patients operated for a mandibular ORN (59 patients). The reconstructions performed with a bone flap (42%), bone composite flap (34%), periosteal free flap (14%), cutaneous flap (4%), or muscular flap (5%) were assessed. The radiological and clinical results and the effect of re-vascularization were analyzed.
Results:
A skin paddle was required in 47% of cases, impairing dental rehabilitation. The bone flap had to be osteotomized in 25% of iliac flaps, and 75% of fibula flaps. The free flap reconstruction had a 90% success rate. Complications were observed in 60% of cases and were more frequent when the stage was higher. The analysis of the surgical technique allowed determining its interest.
Discussion:
The analysis of results showed the feasibility of this technique in irradiated tissues. The iliac bone free flap was the best solution taking into consideration the shape, bone volume and vestibular morphology. The osteo-induction by a non-irradiated tissue transplantation was demonstrated clinically and radiologically.
