Mandibular Osteoradionecrosis: Mandibular Preservation Using Humeral Periosteal Free Flap Wrapping

Management of mandibular osteoradionecrosis (ORN) is challenging and often requires large surgical resection. Alternatively, mandibular preservation and wrapping with a periosteal free flap may achieve healing in selected patients. Our objective was to assess the success rate and morbidity of revascularization of mandibular ORN using a humeral periosteal free flap.

A retrospective study was performed using medical records of patients who had undergone humeral periosteal free flap reconstruction for mandibular ORN. Clinical data, including age, gender, ORN site, ORN grade according to the Notani classification, clinical and radiological outcomes and complications were analyzed. The primary endpoint was ORN healing, defined as complete resolution of the main symptom (exposure, chronic infection, fistula, or fracture) at 6 months postoperatively.

A total of 36 lesions in 34 patients with mandibular ORN associated with bone exposure and/or infection and/or pathologic fracture were included. ORN healing at 6 months was achieved in 64.7% (n = 22/34) of treated sites in the overall cohort and in 91.6% (n = 22/24) of patients with a viable flap.

The humeral periosteal free flap can be considered a reasonable surgical option for advanced mandibular ORN to avoid segmental mandibulectomy.