Microvascular reconstruction of midface osteoradionecrosis
Larissa Sweeny1,2, Neeraja Konuthula1, Ryan Jackson3
1Department of Otolaryngology - Head and Neck Surgery, University of Miami, Miami, Florida, USA.
Head & Neck
|June 7, 2024
Summary
Free flap reconstruction for head and neck osteoradionecrosis (ORN) shows an 87% survival rate. Preoperative factors like fistulas and fractures significantly impact postoperative diet tolerance, highlighting the importance of nutritional status in ORN management.
Area of Science:
- Oral and Maxillofacial Surgery
- Plastic Surgery
- Oncology
Background:
- Head and neck osteoradionecrosis (ORN) is a rare but serious complication following radiation therapy.
- Midface ORN often necessitates complex reconstruction using free flaps (FF).
- This study addresses the outcomes of FF reconstruction for midface ORN in a multi-institutional setting.
Purpose of the Study:
- To evaluate the outcomes of free flap reconstruction for midface osteoradionecrosis.
- To identify preoperative factors influencing postoperative complications and functional recovery.
- To assess the impact of nutritional status on free flap survival and patient diet tolerance.
Main Methods:
- Retrospective multi-institutional review of 54 patients undergoing FF reconstruction for midface ORN between 2005 and 2022.
- Analysis of free flap survival rates.
- Correlation of preoperative patient factors (e.g., prior surgery, pathologic fracture, intraoral bone exposure, fistula) with postoperative outcomes, including diet tolerance and complications.
- Assessment of nutritional markers (albumin, prealbumin) and their relation to outcomes.
Main Results:
- The overall free flap survival rate was 87%.
- Patients with preoperative history of prior head and surgery, pathologic fracture, exposed intraoral bone, or fistula were less likely to tolerate a regular diet at 3 months postoperatively.
- Lower mean albumin levels were associated with FF survival (p=0.03).
- Low prealbumin levels correlated with a higher likelihood of hematoma evacuation (p=0.02).
Conclusions:
- Preoperative nutritional status significantly impacts postoperative complications in midface ORN patients undergoing FF reconstruction.
- The presence of a fistula, pathologic fracture, and intraoral bone exposure are critical preoperative indicators of decreased postoperative diet tolerance.
- Optimizing nutritional status preoperatively may be crucial for improving functional outcomes after FF reconstruction for midface ORN.
