Microsurgical reconstruction of complex oromandibular defects: An update

Area of Science:

• Oral and Maxillofacial Surgery
• Plastic and Reconstructive Surgery
• Head and Neck Oncology

Background:

• Free flaps are the established standard for reconstructing defects of the mandible, tongue, and floor of the mouth.
• Free fibular flaps are highly favored for complex mandibular, tongue, and floor of mouth defects owing to their accessibility, sculptability, and functional results.

Purpose of the Study:

• To review current trends in bone and soft tissue flap reconstruction for complex oromandibular defects.
• To provide an informative overview of surgical principles and technological advancements in the field.

Main Methods:

• Review of current literature on free flap reconstruction techniques for oromandibular defects.
• Discussion of surgical principles including defect evaluation and flap manipulation.
• Highlighting advancements in preoperative planning, such as virtual simulation and stereolithic models.

Main Results:

• Free fibular flaps are a preferred option for mandibular, tongue, and floor of mouth reconstruction.
• Alternative bone flaps include iliac crest; soft tissue options include anterolateral thigh, radial forearm, and nasolabial flaps.
• Computerized planning and stereolithic models improve surgical accuracy and patient-specific reconstruction.

Conclusions:

• Free flaps remain the gold standard for oromandibular reconstruction.
• The free fibular flap offers a versatile and effective solution for complex defects.
• Technological advancements are refining surgical planning and execution for improved patient outcomes.