Transoral Minimal Access Mandibular Reconstruction Using Fibula Free Flap in Osteoradionecrosis.

Area of Science:

• Oral and Maxillofacial Surgery
• Reconstructive Surgery
• Oncology

Background:

• Osteoradionecrosis (ORN) of the mandible often requires complex reconstruction.
• Traditional transcervical approaches for mandibular reconstruction can involve significant morbidity.
• Minimally invasive techniques are sought to improve patient outcomes.

Purpose of the Study:

• To evaluate the efficacy and outcomes of a limited transoral approach for segmental mandibulectomy reconstruction.
• To assess the use of free flap (FFF) reconstruction with minimal access vessel isolation in ORN patients.
• To compare the transoral approach with traditional transcervical methods.

Main Methods:

• Retrospective review of nine patients undergoing FFF reconstruction for mandibular ORN via a transoral approach.
• Analysis of patient demographics, ORN management, preoperative conditions, and surgical outcomes.
• Evaluation of postoperative complications, hospitalization, and long-term follow-up.

Main Results:

• Nine male patients (median age 66) with mandibular ORN underwent transoral FFF reconstruction.
• Most patients had failed conservative ORN management, with prior antibiotic and hyperbaric oxygen therapy.
• The procedure resulted in minimal complications, with all patients achieving clinical and radiographic arrest of ORN at a median follow-up of 13.9 months.

Conclusions:

• A transoral approach for mandibular reconstruction with FFF is a promising alternative for ORN patients.
• This technique may reduce morbidity compared to the traditional transcervical approach.
• The study highlights the potential for improved outcomes with this minimally invasive method.