Autologous freeze-treated bone for mandibular reconstruction after malignant tumor resection: a study of 72 patients☆
Received 21 April 2008 published online 09 March 2009.
Abstract
Objective
The aim of the study was to assess the possibility of mandibular reconstruction with autologous freeze-treated bone after mandibular resection for malignant tumors.
Patients
The medical records of 72 consecutive patients surgically treated with segmental mandibular resection and reconstruction with autologous freeze-treated mandible were reviewed.
Results
All tumors were in stage T4a for deep infiltration of the mandible. Soft tissues were reconstructed with a direct mucosal closure (4 cases), with a pedicled pectoralis flap (17 cases), and with a forearm fasciocutaneous free flap without or with radial periosteum (18 and 33 cases). Four patients presented with a recurrence after previous surgery and radiotherapy, and 26 patients underwent postoperative radiotherapy. We resected the mental arch in 35 cases and the lateral mandible in 37 cases. Forty-one patients (56.9%) retained their autologous mandibular graft. In 31 cases, the bone graft was removed for mucosal dehiscence and bone infection. Lateral resections achieved a better success rate than anterior resections (75.7% vs 37.1%). The pedicled pectoralis flap achieved the worse success rate (35.3%) in comparison with forearm fasciocutaneous flap (66.7%). Postoperative radiotherapy decreased the success rate (40.0% vs 69.1%).
Conclusions
Mandibular reconstruction with autologous frozen bone is an interesting alternative to more sophisticated methods for patients with oral cancer involving the bone. It is time and cost sparing in comparison to fibula or iliac crest flaps. However, in spite of any intraoral reconstruction, the success rate is not stirring. In our opinion, this type of mandibular reconstruction must be reserved to patients with lateral tumors, with poor prognosis, or severe comorbidities not allowing more complex bone reconstruction.
Department of Cranio-Maxillo-Facial Surgery, Istituto Nazionale per lo Studio e la Cura dei Tumori di Milano (National Cancer Institute), Milano, Italy
Corresponding author. Department of Cranio-Maxillo-Facial Surgery, Istituto Nazionale per lo Studio e la Cura dei Tumori di Milano National Cancer Institute, Via Venezian 1, 20133 Milano, Italy. Tel.: +39 02 23902382; fax: +39 02 23902371.
☆ Presented in part at the 10th International Congress on Oral Cancer, Island of Crete, Greece, 19 to 24 April 2.
ABSTRACT