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Report of 210 Cases

Mark L. Urken, MD; Daniel Buchbinder, DMD; Peter D. Costantino, MD; Uttam Sinha, MD; Devin Okay, DDS; William Lawson, MD, DDS; Hugh F. Biller, MD

Arch Otolaryngol Head Neck Surg. 1998;124:46-55.

Objective  To review the experience of 1 microvascular surgeon during an 11-year period in performing 210 vascularized bone-containing free flaps for oromandibular reconstruction.

Design  Retrospective medical records review of patients who underwent primary and secondary oromandibular reconstruction with the use of vascularized bone free flaps.

Setting  Academic medical center.

Patients  A total of 201 patients underwent 210 composite free-flap reconstructions of the mandible for various disorders and with a range of bony and soft tissue defects.

Intervention  All patients underwent the microvascular transfer of vascularized bone flaps from the ilium, fibula, or scapula. In selected cases, 2 simultaneous free flaps were transferred to achieve an optimal bone and soft tissue reconstruction. Endosteal dental implants were used in 81 patients, with a total of 360 fixtures placed during these 11 years.

Main Outcome Measures  The success of microvascular free tissue transfer, dental implant extrusion, and short- and long-term complications at the recipient and donor sites.

Results  Of the 210 mandibular reconstructions that were performed, 202 were successful in reestablishing mandibular continuity. Reexploration for vascular-related complications was done in 16 patients, 8 of whom were successfully treated, yielding an overall success rate of 96%. The overall success rate for endosteal dental implants was 92%. The implant success rate was 86% when the bone in which the fixtures were placed was irradiated postoperatively. The success rate was 64% in the 14 fixtures that were placed into previously irradiated bone.

Conclusions  The success of the use of vascularized bone free flaps in restoring continuity to the mandible is clearly demonstrated in this series. There was an acceptable incidence of donor- and recipient-site complications that resulted in minimal long-term morbidity. The careful selection of a donor site(s) for oromandibular reconstruction allows for an optimal restoration of bony and soft tissue defects. Dental implants can be safely used in oromandibular reconstruction with a high level of success. Placing these implants during the initial surgery shortens the duration for achieving dental rehabilitation and enhances the success of the implants when postoperative radiotherapy is administered.

From the Department of Otolaryngology (Drs Urken, Buchbinder, Costantino, Okay, Lawson, and Biller) and the Division of Oral and Maxillofacial Surgery, Department of Dentistry (Drs Buchbinder and Okay), The Mount Sinai Medical Center, New York, NY, and the Department of Otolaryngology–Head and Neck Surgery, University of Southern California, Los Angeles (Dr Sinha).

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