Composite reconstruction in advanced cancer of the mouth floor: Autogenous frozen‐thawed mandibular bone and free flaps

Abstract

Mandibular symphyseal resection requires composite reconstructions, often with unsatisfactory morphofunctional results. Seven patients with advanced squamous cell carcinoma of the floor of the mouth underwent block resection with immediate reconstruction, using the removed mandible treated with liquid nitrogen and covered with a free forearm flap. In all cases, the resection was radical and no major postoperative complications occurred. Two patients died in 6 months for distant metastases and regional recurrence. In the other 5 patients, no local recurrence occurred at a mean follow-up of 52 months (36-70). Immediate cosmetic and functional results were good. Of the 5 patients, 4 had late complications requiring further surgery. This technique of bone reimplantation produces no donor site morbidity, perfect immediate morphological result, and is of low cost. The free forearm flap is effective in sealing the oral cavity, though further clinical and experimental studies are necessary to reduce late local complications.

Free Periosteal Flaps with Scaffold: An Overlooked Armamentarium for Maxillary and Mandibular Reconstruction

“…For young patients with limited comorbidities this is the best chance for an efficient dental rehabilitation, an acceptable face profile and therefore, for a return to an almost normal social life after treatment. Unfortunately, there are some situations in which the use of a noble reconstruction may be contraindicated: (a) patients with serious comorbidities, (b) BFF failure (acute post-operative or as consequence of adjuvant treatment) and (c) relapsing disease involving the BFF [1,6,7]. The first is a condition that affects the choice of primary treatment, while the latter two affect the choice of sequential salvage treatment.…”

“…Kelley et al firstly proposed the use of FPF in a case midface reconstruction, to optimize the vascularization of an autologous bone graft [5]. Afterwards, several authors proposed a more refined technique with FPF with autologous frozen bone for segmental mandibulectomy [6][7][8]. The first case series belong to Roselli and colleagues and Calabrese and colleagues [6,7].…”

“…Afterwards, several authors proposed a more refined technique with FPF with autologous frozen bone for segmental mandibulectomy [6][7][8]. The first case series belong to Roselli and colleagues and Calabrese and colleagues [6,7]. Subsequently Cantù et al reported a comparative experience on a group of 72 patients who had undergone to mandibular restoration with assorted techniques: among them, 33 underwent reconstruction with a fasciocutaneous forearm FPF associated with autologous frozen bone graft [8].…”

“…Revascularized FPF with support scaffold can represent a possible alternative in decision making algorithm for complex patients, BFF's failure and disease recurrence, being more versatile than other less sophisticated choices such as pedicled flaps with reconstructive plates. However, only few clinical applications in head and neck reconstruction are reported in the literature [5][6][7][8][9][10][11].…”

Tongue Function after Ablative Surgery of the Symphyseal Region of the Mandible for the Treatment of Ameloblastomas in Tanzanian Patients

“…This probably explains the almost complete absence of any study dealing with tongue function after mandibular symphyseal resection. The one study we found deals with seven cases in which a microsurgical radial forearm flap was used along with re-implantation of the resected bone that was treated with liquid oxygen [7]. The authors claimed good functional results without being specific about tongue function.…”