Reconstruction of the mandible for osteoradionecrosis

Haroun, Kareem B.; Coblens, Orly

doi:10.1097/moo.0000000000000571

Cited by 21 publications

(17 citation statements)

References 61 publications

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“…Studies have shown that early intervention with minor surgical procedures combined with pharmacological methods may improve the prognosis of ORN [ 51 ]. Surgical management is generally employed when conservative management is unsuccessful and there is progressive (Notani III) ORN resulting in pathological fractures and draining fistulae [ 52 ]. Those with more advanced ORN may require extensive surgical resections such as segmental mandibulectomy and osteo cutaneous free-flap reconstruction.…”

Section: Review Of the Conditionmentioning

confidence: 99%

Osteoradionecrosis of the jaw: A mini review

Singh

Huryn

Kronstadt

et al. 2022

Front. Oral. Health

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Osteoradionecrosis (ORN) of the jaw is one of the most dreaded complications of head and neck radiation therapy. Despite the evolution of radiation treatment modalities, ORN continues to remain a therapeutic challenge and its etiopathogenesis still remains unclear. It is clinically characterized by exposed necrotic bone within the head and neck radiation field. Over the past years, several studies have reported on the definition, staging, incidence, etiology, and management of this oral complication. In this review, we summarize the literature on ORN and discuss our institutional experience and management strategies that aim to predict and mitigate risk for ORN.

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Section: Review Of the Conditionmentioning

confidence: 99%

Osteoradionecrosis of the jaw: A mini review

Singh

Huryn

Kronstadt

et al. 2022

Front. Oral. Health

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“…Early ORN can be managed conservatively with therapies such as oral hygiene, antibiotics, local debridement, and hyperbaric oxygen 14,15 . However, when progression of ORN results in pathologic fracture, fistulization, and/or severe pain, the most common treatment is resection of involved segments of bone and reconstruction with free tissue transfer 16–18 . Despite this intervention serving as the gold standard for definitive treatment, there is a paucity of data evaluating outcomes, including the incidence of recurrent ORN 19,20 .…”

Section: Introductionmentioning

confidence: 99%

“…14,15 However, when progression of ORN results in pathologic fracture, fistulization, and/or severe pain, the most common treatment is resection of involved segments of bone and reconstruction with free tissue transfer. [16][17][18] Despite this intervention serving as the gold standard for definitive treatment, there is a paucity of data evaluating outcomes, including the incidence of recurrent ORN. 19,20 Few studies to date have evaluated the impact of definitive surgical management of ORN on functional outcomes, such as speech and swallowing.…”

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confidence: 99%

Outcomes after definitive surgery for mandibular osteoradionecrosis

et al. 2022

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Objectives To analyze charges, complications, survival, and functional outcomes for definitive surgery of mandibular osteoradionecrosis (ORN). Materials and Methods Retrospective analysis of 76 patients who underwent segmental mandibulectomy with reconstruction from 2000 to 2009. Results Complications occurred in 49 (65%) patients and were associated with preoperative drainage (odds ratio [OR] 4.40, 95% confidence interval [CI] 1.01–19.27). The adjusted median charge was $343 000, and higher charges were associated with double flap reconstruction (OR 8.15, 95% CI 2.19–30.29) and smoking (OR 5.91, 95% CI 1.69–20.72). Improved swallow was associated with age <67 years (OR 3.76, 95% CI 1.16–12.17) and preoperative swallow (OR 3.42, 95% CI 1.23–9.51). Five‐year ORN‐recurrence‐free survival was 93% while overall survival was 63% and associated with pulmonary disease (HR [hazard ratio] 3.57, 95% CI 1.43–8.94). Conclusions Although recurrence of ORN is rare, surgical complications are common and charges are high. Poorer outcomes and higher charges are associated with preoperative factors.

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“…If conservative management fails, various vascularized osteocutaneous flaps may be utilized for mandibular reconstruction; these commonly comprise those from the fibula or scapula axis, with flap selection based on patient needs and overall health status. [4][5][6] Biologic reconstructive techniques for mandibular condylar reconstruction have historically centered around the use of autogenous ribs. 7 Although obtainable in a sufficient volume and number with minimal postoperative morbidity for the patient, the limitations of this treatment modality are well known.…”

Section: Introductionmentioning

confidence: 99%

Vascularized Fibula TMJ Reconstruction: A Report of Five Cases featuring Computerized Patient-specific Surgical Planning

Powers

Breeze

Erdmann

2022

Plastic and Reconstructive Surgery - Global Open

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Background: Mandibular defects involving the condyle represent a complex reconstructive challenge for restoring proper function of the temporomandibular joint because it requires precise bone graft alignment, or alloplastic materials, for complete restoration of joint function. The use of computerized patient-specific surgical planning (CPSSP) technology can aid in the anatomic reconstruction of mandibular condyle defects with a vascularized free fibula flap without the need for additional adjuncts. The purpose of this study was to analyze clinical and functional outcomes after reconstruction of mandibular condyle defects using only a free fibula graft with the assistance of virtual surgery techniques. Methods: A retrospective review was performed to identify all patients who underwent mandibular reconstruction utilizing CPSSP with only a free fibula flap without any temporomandibular joint adjuncts after a hemimandibulectomy with total condylectomy. Results: From 2018 to 2021, five patients underwent reconstruction of mandibular defects involving the condyle with CPSSP technology and preservation of the native temporomandibular articulating disk. The average age was 62 years (range, 44–73 years). The average follow-up period was 29.2 months (range, 9–46 months). Flap survival was 100% (N = 5). The maximal interincisal opening range for all patients was 22–45 mm with no lateral deviation or subjective joint pain. No patients experienced progressive joint hypomobility or condylar migration. Conclusion: The use of CPSSP technology can aid in the anatomic reconstruction of mandibular condyle defects with a vascularized free fibula flap through precise planning and intraoperative manipulation with optimal functional outcomes.

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Reconstruction of the mandible for osteoradionecrosis

Cited by 21 publications

References 61 publications

Osteoradionecrosis of the jaw: A mini review

Osteoradionecrosis of the jaw: A mini review

Outcomes after definitive surgery for mandibular osteoradionecrosis

Vascularized Fibula TMJ Reconstruction: A Report of Five Cases featuring Computerized Patient-specific Surgical Planning

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