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Microvascular reconstruction of segmental mandibular defects without tracheostomy
Sami P Moubayed1, Daniel A Barker2, Ali Razfar2
1Division of Otolaryngology-Head and Neck Surgery, Université de Montréal, Montreal, Canada sp.moubayed@gmail.com.
Summary
Mandibular reconstruction using vascularized bone-containing free flaps is feasible without elective tracheostomy in select patients. This approach avoids tracheostomy in carefully chosen cases, ensuring successful outcomes.
Area of Science:
- Oral and Maxillofacial Surgery
- Plastic and Reconstructive Surgery
- Head and Neck Oncology
Background:
- Mandibular defects often require complex reconstruction.
- Vascularized bone-containing free flaps are a common reconstructive method.
- The necessity of elective tracheostomy during these procedures is debated.
Purpose of the Study:
- To evaluate the safety and feasibility of mandibular reconstruction using vascularized bone-containing free flaps without elective tracheostomy.
- To identify patient and surgical factors influencing outcomes.
- To report perioperative complications in this patient cohort.
Main Methods:
- Retrospective case series with chart review.
- Analysis of 66 patients undergoing mandibular reconstruction with free flaps between 1995 and 2013.
- Exclusion criteria included elective tracheostomy, bilateral central mandibular defects, tongue/pharyngeal defects, and bilateral neck dissections.
Main Results:
- Fibula free flap was the most common reconstruction method (92.44%).
- Common indications for resection included osteoradionecrosis, parotid carcinoma, oral squamous cell carcinoma, and osteomyelitis.
- No perioperative deaths or flap failures occurred; one emergent tracheostomy was needed, and two patients had respiratory complications.
Conclusions:
- Mandibular reconstruction with vascularized bone-containing free flaps can be safely performed without elective tracheostomy in carefully selected patients.
- Patient selection is crucial, excluding those with bilateral central mandibular defects, significant tongue/pharyngeal defects, or bilateral neck dissections.
