Heterotopic ossification in the submental triangle remote from the vascular pedicle after reconstruction with a fibular free flap: a previously unreported complication

Panaretou, E.; Blythe, J.; Conti, Marco; Brennan, Peter A.

doi:10.1016/j.bjoms.2015.08.266

Cited by 10 publications

(5 citation statements)

References 7 publications

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“…Common clinical symptoms of pedicle ossification include trismus, hard swelling in the surgical region (submandibular, cheek, and submental region), pain, or discomfort during swallowing or chewing 7–9 . The earliest occurrence of pedicle ossification was 1 month after the operation, and the latest presentation was 9 years 9,10 . It has been reported that ossification might stop after some time, so many scholars have suggested that secondary surgical interventions should be primarily symptom‐driven and that prophylactic resection should not be performed 11 .…”

Section: Discussionmentioning

confidence: 99%

“… 7 , 8 , 9 The earliest occurrence of pedicle ossification was 1 month after the operation, and the latest presentation was 9 years. 9 , 10 It has been reported that ossification might stop after some time, so many scholars have suggested that secondary surgical interventions should be primarily symptom‐driven and that prophylactic resection should not be performed. 11 The same was true for the case study presented in this paper: no clinically relevant worsening of symptoms was observed 6 months later.…”

Section: Discussionmentioning

confidence: 99%

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Pedicle ossification after fibular flap reconstruction of maxillary defects: A case report and literature review

Zou

2024

Clinical Case Reports

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Key Clinical MessageThe phenomenon of vessel pedicle ossification is a noteworthy aspect of the repair and reconstruction of maxillofacial defects. Imaging findings typically reveal high‐density shadows within the vascular pedicle pathway, which may be managed through conservative observation or surgical intervention as deemed appropriate.AbstractVessel pedicle ossification is a relatively uncommon complication associated with the reconstruction of oral and maxillofacial tissue defects using free tissue flap repair. In this paper, we report a case of pedicle ossification and conduct a comprehensive review of previous literature. A 39‐year‐old man presented with a limited ability to open his mouth 6 months after fibular flap reconstruction of the mandible. Plain film X‐ray and computed tomography (CT) indicated pedicle ossification. Two years after the initial operation, the restriction in the patient's ability to open his mouth had not worsened, although there were more pronounced radiographic abnormalities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pedicle ossification after fibular flap reconstruction of maxillary defects: A case report and literature review

Zou

2024

Clinical Case Reports

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“…Several groups have proposed to change the technique of harvesting fibular flap, with removal of periosteum. [18][19][20] A recent surgical study in which 20 patients had a modified harvesting procedure with removal of the fibular periosteum before vascular anastomois revealednone of these patients developed flap ossification in the 18 months following VFFF reconstruction. 2 However, the risks and benefits of these new techniques are still not well established.…”

Section: Discussionmentioning

confidence: 99%

Vascular Pedicle Ossification After Jaw Reconstruction With Fibular Free Flap

Han

Zhang

Sun

2023

Journal of Craniofacial Surgery

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construction method. However, it can be difficult to find intact vessels at the amputated stump, especially in cases of animal bites. When there is an amputated stump and immediate microsurgical replantation is not possible, immediate composite graft and delayed reconstruction with a paramedian forehead flap and simultaneous cartilage graft can be a good option in cases of nasal tip amputation. CONCLUSIONAn immediate composite graft followed by a paramedian forehead flap with a simultaneous cartilage graft can be a feasible option for nasal tip reconstruction after amputation by an animal bite.

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“…The local mechanical theory attributed pedicle ossification to the callus formation on the reconstructed maxilla or mandible from masticatory stresses inducing BMP signaling . A recent case report by Panaretou et al presented a case of heterotopic bone formation on the fibula bone away from the pedicle 9 years after FFF mandibular reconstruction. The authors suggested local mechanical forces inducing BMP signaling or a possibility of detached periosteum or exudate bone marrow at the time of surgery as a potential etiology of the phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Modified fibula free flap harvesting technique for prevention of heterotopic pedicle ossification

et al. 2019

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Background: Pedicle ossification is thought to arise from the residual perieosteum left along the pedicle during the fibula free flap (FFF) harvesting. Pedicle ossification in head and neck reconstruction can cause trismus, pain on mastication/turning the neck, or neck swelling. Methods: Two patients reported in this article developed severe trismus within 6 months after mandibular reconstruction with FFF. CT scans revealed ossification along the vascular pedicle interfering with mouth opening. Both patients underwent surgical debridement of the heterotopic bone. Results: Surgical debridement of the heterotopic bone led to the resolution of trismus in both patients with pedicle ossification. Conclusions: Pedicle ossification is a complication of FFF that can be effectively managed by removal of heterotopic bone. However, it is best prevented at the time of initial surgery. In this article, a new modified FFF harvesting technique is introduced to prevent pedicle ossification and reduce the ischemia time. K E Y W O R D S fibula, flap, ossification, pedicle, technique

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Heterotopic ossification in the submental triangle remote from the vascular pedicle after reconstruction with a fibular free flap: a previously unreported complication

Cited by 10 publications

References 7 publications

Pedicle ossification after fibular flap reconstruction of maxillary defects: A case report and literature review

Pedicle ossification after fibular flap reconstruction of maxillary defects: A case report and literature review

Vascular Pedicle Ossification After Jaw Reconstruction With Fibular Free Flap

Modified fibula free flap harvesting technique for prevention of heterotopic pedicle ossification

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