Reconstruction of the marginal mandibulectomy defect: an update

Deleyiannis, Frederic W.-B.; Dunklebarger, Joshua; Lee, Edward; Gastman, Brian; Lai, Stephen; Ferris, Robert; Myers, Eugene N.; Johnson, Jonas

doi:10.1016/j.amjoto.2006.10.017

« Previous Next »American Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume 28, Issue 6 , Pages 363-366, November 2007

Reconstruction of the marginal mandibulectomy defect: an update☆

Frederic W.-B. Deleyiannis, MD, MPhil, MPH
- Division of Plastic and Reconstructive Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Otolaryngology and Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Corresponding author. Suite 6B Scaife Hall, 3550 Terrace Avenue, Pittsburgh, PA 15261, USA. Tel.: +1 412 692 7964; fax: +1 412 692 8614.
Joshua Dunklebarger, MD
- Department of Otolaryngology and Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, USA
Edward Lee, MD
- Division of Plastic and Reconstructive Surgery, University of Pittsburgh, Pittsburgh, PA, USA
Brian Gastman, MD
- Division of Plastic and Reconstructive Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Otolaryngology and Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, USA
Stephen Lai, MD
- Department of Otolaryngology and Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, USA
Robert Ferris, MD, PhD
- Department of Otolaryngology and Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, USA
Eugene N. Myers, MD
- Department of Otolaryngology and Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, USA
Jonas Johnson, MD
- Department of Otolaryngology and Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, USA

Received 7 October 2006

Abstract

Objective

The purpose of this study is to provide an update to the reconstructive management of the marginal mandibulectomy defect.

Study design

Twenty-six consecutive patients were retrospectively reviewed.

Methods

Patient and tumor variables were extracted from the medical record. Outcomes that were examined included method of reconstruction, frequency of osteoradionecrosis, and resumption of an oral diet.

Results

Fifteen (57.7%), 8 (30.8%), and 3 (11.5%) patients were reconstructed with a skin graft, primary closure, or a radial forearm free flap, respectively. Indications for a radial forearm free flap were reconstruction of an associated subtotal glossectomy defect, a through-and-through cheek defect, and a maxillectomy defect. Five patients reconstructed with a skin graft also received postoperative radiation therapy. One (20%) developed osteoradionecrosis. Excluding patients with recurrent tumors (n = 5) or osteoradionecrosis (n = 1), all patients at last follow-up were maintaining an oral diet.

Conclusions

Skin graft remains a preferred method of reconstruction for the marginal mandibular defect. A free flap is reserved for those marginal defects where additional soft tissue is needed to reconstruct subtotal glossectomy defects or defects of the midface and/or maxilla. Because of the potentially increased risk of osteoradionecrosis, reconstruction with a free flap instead of a skin graft should be considered if a patient will receive postoperative radiation therapy.