[Secondary repair of oro-pharyngectomy with mandibular resection and radionecrosis]

There are two pitfalls to be avoided in transmandibular buccopharyngectomy: mandibular amputation and inversely a contemplative wait-and-see attitude. Preservative measures require a precise evaluation of bone invasion, surgical approaches respecting the lip and cutaneo-muscular flaps, and an early assessment of the secondary effects of radiotherapy. Reasonable use of bone periosteal free flaps and striving for immediate reconstruction of each defect certainly leads to an interventionist behavior, but which can be conducted under better conditions and more attainable objectives than after mandibular deformation, a pharyngostomia or recent radionecrosis. Microsurgical procedures are nothing more than technical mastery and can lead to arrogant behavior. Fifty cases illustrate this position.