Mandibular reconstruction in elderly patients

Miyamoto, Shimpei; Higashino, Takuya; Sakuraba, Minoru

doi:10.1002/jso.25059

Cited by 9 publications

(7 citation statements)

References 22 publications

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“…Old age does not increase the risk of donor site complication or flap failure [67], but it does indicate a higher systemic complication and more difficulty in masticatory recovery. Sugiura [68] reported 9 out of 17 elderly patients (> 80 years old) had a systemic complication, in which delirium is the most common type.…”

Section: Mandibular Reconstructionmentioning

confidence: 97%

Complication of osteo reconstruction by utilizing free vascularized fibular bone graft

Zhou

et al. 2020

BMC Surg

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The success of free vascularized fibular bone graft (FVFBG) has accelerated the osteo reconstruction which results from trauma, resection of a tumor or an infectious bone segment, or correction of congenital deformity. But the complication behind should not be overlooked. The failure could necessitate a second surgery, which prolong the rehabilitation period and produce further health cost. Worst, the patients may suffer a permanent impaired ankle function, or a sustained morpho-functional loss on reconstructive area which are hard to save. To provide an overview of the complication related to reconstruction by FVFBG, a narrative review is conducted to identify the complications including their types and rates, the contributing factors, the approaches to measure and the techniques to avoid. Methodologically, by quick research on Pubmed and abstract reading of reviews, we characterize five reconstructive areas where FVFBG were most frequently applied: extremities, mandible, spine, osteonecrosis of femoral head, and penile. Following, the complications on different reconstructive areas are retrieved, studied and presented in five (or more specifically, six) separate sections. By the way, meaningful difference between FVFBG and other bone flap was presented in a few words if necessary. Donor-site morbidities were studied and summarized as a whole. In these literatures, the evidences documented on limb and mandibular reconstruction have the fullest detail, followed by the spine and lastly the penile. In conclusion, FVFBG, though a mature technique, needs further deep and comprehensive study and maybe device-based assistance to achieve better reconstructive effect and minimize donor-site damage.

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Section: Mandibular Reconstructionmentioning

confidence: 97%

Complication of osteo reconstruction by utilizing free vascularized fibular bone graft

Zhou

et al. 2020

BMC Surg

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“…38 The risk of complications mainly appears to be tied to post-operative dentition, post-operative radiation therapy and dental rehabilitation. Close post-operative maintenance of the occlusal relationship and the surrounding tissues can decrease the risk for complications, 34,35 and the same appears to be true for customized plates when compared to the ready-made type. 40 Our presented case was closely monitored, and this strategy proved to work life-long.…”

Section: Discussionmentioning

confidence: 98%

“…The outcome of treatment can be more correctly assessed when considering these factors. 1,32 The use of reconstruction plates is associated with a high risk of plate-related fractures, plate exposure and screw fracture, [33][34][35] although plate exposure has been tied to both the type of soft tissue flap and radiotherapy. 36 Plate only reconstruction, lateral defects and post-operative dentition is strongly associated with plate fractures.…”

Section: Discussionmentioning

confidence: 99%

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Only a Plate? Nine-Year Follow-Up After Partial Mandibulectomy and Reconstruction With Titanium Plate

Hashemi

Thor

2021

Craniomaxillofacial Trauma & Reconstruction Open

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Background: Oral squamous cell carcinoma is the main malignancy of the oral cavity; floor of the mouth and the lateral border of the tongue being the most affected sites. This kind of oral neoplasms may require mandibular resection and reconstruction. Treatment options for such mandibular defects include bone grafts, free flaps, and reconstruction plates. Today, the commonly used treatment method is vascularized fibula flaps due to its many advantages when compared to other methods. However, it is a complex procedure and demands much of both practitioners and the patient. Case Presentation: In this report, we present a case of oral squamous cell carcinoma of the gingiva of the mandible which was treated with a partial mandibulectomy and resection. Because of the patients age and fragility an immediate mandibular reconstruction with a pre-shaped reconstruction plate, without hard or soft tissue transfer, was performed. Yearly controls showed pleasing results both aesthetically and functionally and the patient showed no plate-related complications up until the patient’s death, 9 years later. Conclusion: With this case, we would like to illustrate that using reconstruction plates only may be a viable option in selected cases for continuity defects of the mandible, specifically in fragile patients less suitable for more demanding surgical interventions.

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“…2 A study of mandibular free flap reconstruction in the elderly argues that soft tissue flaps are indicated for posterior mandibular defects in those patients older than 75 years of age and those with poor dental occlusion. 9 Soft tissue free flaps should be considered for posterior mandibular reconstruction, but only in the appropriate context. Those undergoing adjuvant radiation or bisphosphonate therapy may avoid unnecessary osteonecrosis with a soft tissue free flap.…”

Section: Discussionmentioning

confidence: 99%

Early and Late Complications of Mandibulectomy Free Flap Reconstruction: Does the Selective Use of Soft Tissue Only Flaps Reduce Complications?

McBee,

DiLeo,

Keehn

et al. 2024

Ann Otol Rhinol Laryngol

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Purpose: This study aims to evaluate the factors most associated with early and late complications following microvascular free tissue transfer (MVFTT) after mandibulectomy. Methods: A retrospective review of patients undergoing MVFTT after segmental mandibulectomy from September 2016 to February 2021 was performed across a single academic institution. Surgical variables were collected, including the location of the resultant mandibular defect (anterior vs posterior) and flap type (osseous or non-osseous). The primary outcome variables included postoperative complications (early, <90 days; and late, >90 days) and the patients’ functional status (return to oral intake). Descriptive statistics, chi-square test, Fischer’s exact test, and 2-sample t tests were used to analyze differences among variables. Results: We analyzed a cohort of 114 consecutive patients with mandibular defects, comprising 57 anterior and 57 posterior defects. Bony free flaps with hardware were used to reconstruct 98% of anterior defects compared to 58% of posterior defects ( P < .001). All soft tissue only flaps did not utilize any hardware during the reconstruction. Anterior defects demonstrated more late complications requiring additional surgery (30% vs 9%, P = .04). A secondary analysis of posterior mandibular reconstructions compared soft tissue only flaps and bony free flaps with hardware and showed equivalent rates of early (12% vs 13%, P > .99) and late (9% vs 8%, P > .99) complications requiring additional surgery while demonstrating a similar return to full oral competence (55% vs 46%, P = .52) and recovery of a 100% oral diet (67% vs 54%, P = .53). Conclusion: Osseous free tissue transfer for segmental mandibular defects remains the gold standard in reconstruction. In our patient cohort, anterior mandibular defects are associated with greater late (>90 day) complications requiring additional surgery. Comparable outcomes may be achieved with soft tissue only versus osseous free flap reconstruction of posterior mandibular defects.

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Mandibular reconstruction in elderly patients

Abstract: Mandibular reconstruction plate and soft-tissue flap can be good alternatives to vascularized bone graft in the elderly. Our algorithm uses defect type, patient age, and postoperative Eichner index to determine reconstructive technique.

Cited by 9 publications

References 22 publications

Complication of osteo reconstruction by utilizing free vascularized fibular bone graft

Complication of osteo reconstruction by utilizing free vascularized fibular bone graft

Only a Plate? Nine-Year Follow-Up After Partial Mandibulectomy and Reconstruction With Titanium Plate

Early and Late Complications of Mandibulectomy Free Flap Reconstruction: Does the Selective Use of Soft Tissue Only Flaps Reduce Complications?

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