Mandibular reconstruction using free bone flap after preoperative chemoradiation.

Area of Science:

• Oncology
• Head and Neck Surgery
• Reconstructive Surgery

Background:

• Advanced head and neck cancers often require combined treatment modalities including surgery.
• Segmental mandibulectomy presents significant reconstructive challenges, particularly when combined with radiation therapy and chemotherapy.
• Optimal timing of surgery relative to other treatment modalities remains a subject of ongoing debate.

Purpose of the Study:

• To evaluate the impact of preoperative irradiation or chemoradiation on microvascular reconstruction outcomes following segmental mandibulectomy.
• To assess the viability and success of free bone flap reconstructions in patients receiving preoperative radiation therapy.

Main Methods:

• Analysis of a series of 10 patients treated with segmental mandibulectomy and preoperative irradiation or chemoradiation between 1999 and 2006.
• Surgery was performed within 5 weeks following radiation therapy.
• Assessment of microvascular free bone flap viability at the last follow-up.

Main Results:

• 9 out of 10 reconstruction flaps were vital at the last follow-up.
• Patient outcomes were comparable to those reported for postoperative irradiation or chemoradiation.
• Preoperative irradiation did not demonstrate a negative impact on microvascular reconstruction success.

Conclusions:

• Preoperative irradiation is a viable option for head and neck cancer patients undergoing segmental mandibulectomy.
• Microvascular reconstruction with free bone flaps is successful in this patient group.
• This approach offers an equal treatment alternative for advanced head and neck cancer requiring mandibulectomy.