Mandibular Osteoradionecrosis: Use of Sequential Fibula Free Flaps for a Remote Sequence of Complications

Abstract

Mandibular osteoradionecrosis is a serious complication of radiotherapy that often leads to severe facial deformity, intolerable pain, fracture, sequestration of devitalized bone and fistulas. The prophylaxis of this severe complication is a major goal in modern combined tumor therapy, but once the pathology is established, conservative treatment modalities are used in almost all patients in an effort to control progression. Radical surgery should only be instituted when conservative methods fail or when severe bone and softtissue necrosis prevails. Pathologic fractures and chronic fistulae are clear indicators for radical surgical management. This paper document a case report of severe bilateral mandibular osteoradionecrosis reconstructed with two sequencial osteocutaneous fibular free flap. The authors discuss the different alternatives of treatment and the most important steps for a successful management of this challenge.

Surgical Management of Osteoradionecrosis: Perioperative Problems Encountered during 19 Years of Experience Managing Complicated Cases

“…Necrosis of the mandible may result in nonunion, pathological fracture, and orocutaneous fistula 20,21) . The most common free flaps used are composite tissues, which include the bone from the fibula, scapula, iliac crest, or radius 22) .…”