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O93. Maxillofacial reconstruction with the free fibular flap: 13-year experience in a regional hospital in Hong Kong
to 45% but it was not statistically significant (p = 0.67). Furthermore no statistical difference between the different reconstruction methods was found. Discussion: Despite the relatively high rate of complication in alloplastic mandibular reconstruction, it has to be borne in mind that patients with mandibular resection have advanced malignancies. Consequently, most of them are in a rather poor medical condition since microsurgical reconstruction is not primarily indicated due to longer operation times with higher risks. Therefore, alloplastic reconstruction devices are the treatment of choice in many patients. doi:10.1016/j.oos.2009.06.176
O92. Osseocutaneous transplantation for mandibular osteoradionecrosis S.P. Chandarana *, E.J.P. Chanowski, K.A. Casper, J.S. Moyer, J. Lee, D.B. Chepeha University of Michigan Health System, United States Introduction: Osteoradionecrosis leads to poor tissue quality due to decreased vascularity associated with underlying infection, structural instability of the mandible and possible residual malignancy. The objective of this study was to describe the management and outcomes of patients in whom conservative treatment of mandibular osteoradionecrosis failed. Methods: In this retrospective case series, eligible patients, treated at a tertiary medical center, had a history of radiotherapy to the mandible, failed conservative management for osteoradionecrosis, and underwent composite resection with osseocutaneous revascularized tissue transplantation. Variables studied included patient demographics, treatment, functional outcome and complications. Between 1999 and 2006, 13 patients met eligibility criteria. Extent of osteoradionecrosis included: three draining sinuses, four fistulas, five pathologic fractures and one concurrent fistula/ fracture. Thirteen osseocutaneous transplants were performed including: five fibulas, five latissimus dorsi, two iliac crests and one scapula. Results: Nine patients were treated successfully with stable reconstructions for osteoradionecrosis at 2 year follow-up. One patient was not evaluable due to a second primary. Of the three treatment failures, two had persistent, contralateral osteoradionecrosis and one died from peri-operative cardiopulmonary disease. Eight/9 successfully treated patients maintained their nutrition solely by mouth (median score 5/6), had no restriction in range of liquids (median 6/6), and tolerated a soft diet or better (median 3/6). One/ 9 remained G-tube dependent despite controlled osteoradionecrosis. Seven/9 patients had understandable speech (median 4/5) and were comfortable speaking in public (median 5/5). Eight/13 patients required operative intervention for post-operative wound complications including four with delayed transplant breakdown requiring additional revascularized tissue transplantation. Conclusions: Despite significant post-operative wound complications requiring operative intervention, refractory mandibular osteoradionecrosis was treated successfully with revascularized tissue transfer in 9/12 evaluable patients (75%). In successfully treated patients, median speech/swallowing scores were highly functional, but the remaining radiation-damaged soft tissue resulted in higher local wound complications and a modified solid diet. doi:10.1016/j.oos.2009.06.177
87
O93. Maxillofacial reconstruction with the free fibular flap: 13year experience in a regional hospital in Hong Kong J.Y.W. Mak *, W.Y. Cheung Kwong Wah Hospital, Hong Kong Objective: To evaluate the use, indications and outcomes of the fibular osteocutaneous free flap in reconstruction of maxillofacial defects. Method: We conducted a retrospective review of patients requiring immediate maxillofacial reconstruction with fibular osteocutaneous free flap after tumor resection between May 1995 and November 2008. Tumor characteristics, details of reconstruction and outcome, including flap survival and perioperative complications were reviewed. Results: From May 1995 to November 2008, 76 patients underwent immediate maxillofacial reconstruction with fibular osteocutaneous free flap after tumor resection. The median age was 65 (range 11–88), and the male:female ratio was 52:24. Squamous cell carcinoma was the commonest cell type, comprising 77% of all cases (n = 61). Eighty-eight percent of the tumors (n = 70) were located in the oral cavity and oropharynx, whereas 9% (n = 7) in the maxillofacial region. Two cases involved the salivary glands. Segmental mandibulectomy was performed in 70 cases. The mean bony defect was 9.0 cm. The double-barrel fibular flap was used in 21 cases and condyle reconstruction was performed in three cases with satisfactory functional outcome. Seven patients underwent maxillectomy followed by immediate reconstruction, with successful restoration of the midface projection and contour. A total of 79 free fibular osteocutaneous flaps were performed and nine cases required double flaps for reconstruction. Operative morbidity was 48%. There were three case of total flap loss (4%) and eight cases of flap compromise. Re-exploration rate was 10% and the salvage rate was 63%. Other flap related complications included flap necrosis, bleeding, osteomyelitis and radionecrosis. There were 21 recipient site-related complications, including wound infection, fistula formation, leakage and wound dehiscence. Donor site-related complications occurred in 14 cases. Instrumentation related complication rate was 11%. There was one 30-day mortality due to a sudden cardiac event. Overall 5-year survival was 24%. Conclusion: The use of fibular osteocutaneous free flap for reconstruction of maxillofacial defect is highly reliable. Its versatility allows functional and aesthetic maxillofacial reconstruction, as well as adequate support for osteointegrated implants. It could be the flap of choice for selected maxillary and mandibular defects requiring preservation of contour and projection. doi:10.1016/j.oos.2009.06.178
O94. Reconstruction of mandibular defects – A clinical review over a 25-year period A. Eckardt *, B. Sinikovic, H. Kokemüller, S. Friedrichs, N.-C. Gellrich Dept. of Oral and Maxillofacial Surgery, Hannover Medical School, Germany Introduction: Reconstruction of trauma- or tumor-related mandibular defects is a well established surgical procedure and an essential part of the patient’s rehabilitation process. In view of many reconstructive options as far as donor site selection, timing of surgery is concerned, there still exists some controversy. Material and methods: Aim of the present clinical investigation was a retrospective review of all reconstructions of mandibular defects of various etiologies being performed at a single institution in a
Oral AbstractsPoster ListOrals ListPan. Disc. & Symp. Abs.Keynote Abs.Keynote Bios.ProgramIAOOWelcomeCommittee Listings
Oral abstracts / Oral Oncology Supplement 3 (2009) 56–122
O92. Osseocutaneous transplantation for mandibular osteoradionecrosis S.P. Chandarana *, E.J.P. Chanowski, K.A. Casper, J.S. Moyer, J. Lee, D.B. Chepeha University of Michigan Health System, United States Introduction: Osteoradionecrosis leads to poor tissue quality due to decreased vascularity associated with underlying infection, structural instability of the mandible and possible residual malignancy. The objective of this study was to describe the management and outcomes of patients in whom conservative treatment of mandibular osteoradionecrosis failed. Methods: In this retrospective case series, eligible patients, treated at a tertiary medical center, had a history of radiotherapy to the mandible, failed conservative management for osteoradionecrosis, and underwent composite resection with osseocutaneous revascularized tissue transplantation. Variables studied included patient demographics, treatment, functional outcome and complications. Between 1999 and 2006, 13 patients met eligibility criteria. Extent of osteoradionecrosis included: three draining sinuses, four fistulas, five pathologic fractures and one concurrent fistula/ fracture. Thirteen osseocutaneous transplants were performed including: five fibulas, five latissimus dorsi, two iliac crests and one scapula. Results: Nine patients were treated successfully with stable reconstructions for osteoradionecrosis at 2 year follow-up. One patient was not evaluable due to a second primary. Of the three treatment failures, two had persistent, contralateral osteoradionecrosis and one died from peri-operative cardiopulmonary disease. Eight/9 successfully treated patients maintained their nutrition solely by mouth (median score 5/6), had no restriction in range of liquids (median 6/6), and tolerated a soft diet or better (median 3/6). One/ 9 remained G-tube dependent despite controlled osteoradionecrosis. Seven/9 patients had understandable speech (median 4/5) and were comfortable speaking in public (median 5/5). Eight/13 patients required operative intervention for post-operative wound complications including four with delayed transplant breakdown requiring additional revascularized tissue transplantation. Conclusions: Despite significant post-operative wound complications requiring operative intervention, refractory mandibular osteoradionecrosis was treated successfully with revascularized tissue transfer in 9/12 evaluable patients (75%). In successfully treated patients, median speech/swallowing scores were highly functional, but the remaining radiation-damaged soft tissue resulted in higher local wound complications and a modified solid diet. doi:10.1016/j.oos.2009.06.177
87
O93. Maxillofacial reconstruction with the free fibular flap: 13year experience in a regional hospital in Hong Kong J.Y.W. Mak *, W.Y. Cheung Kwong Wah Hospital, Hong Kong Objective: To evaluate the use, indications and outcomes of the fibular osteocutaneous free flap in reconstruction of maxillofacial defects. Method: We conducted a retrospective review of patients requiring immediate maxillofacial reconstruction with fibular osteocutaneous free flap after tumor resection between May 1995 and November 2008. Tumor characteristics, details of reconstruction and outcome, including flap survival and perioperative complications were reviewed. Results: From May 1995 to November 2008, 76 patients underwent immediate maxillofacial reconstruction with fibular osteocutaneous free flap after tumor resection. The median age was 65 (range 11–88), and the male:female ratio was 52:24. Squamous cell carcinoma was the commonest cell type, comprising 77% of all cases (n = 61). Eighty-eight percent of the tumors (n = 70) were located in the oral cavity and oropharynx, whereas 9% (n = 7) in the maxillofacial region. Two cases involved the salivary glands. Segmental mandibulectomy was performed in 70 cases. The mean bony defect was 9.0 cm. The double-barrel fibular flap was used in 21 cases and condyle reconstruction was performed in three cases with satisfactory functional outcome. Seven patients underwent maxillectomy followed by immediate reconstruction, with successful restoration of the midface projection and contour. A total of 79 free fibular osteocutaneous flaps were performed and nine cases required double flaps for reconstruction. Operative morbidity was 48%. There were three case of total flap loss (4%) and eight cases of flap compromise. Re-exploration rate was 10% and the salvage rate was 63%. Other flap related complications included flap necrosis, bleeding, osteomyelitis and radionecrosis. There were 21 recipient site-related complications, including wound infection, fistula formation, leakage and wound dehiscence. Donor site-related complications occurred in 14 cases. Instrumentation related complication rate was 11%. There was one 30-day mortality due to a sudden cardiac event. Overall 5-year survival was 24%. Conclusion: The use of fibular osteocutaneous free flap for reconstruction of maxillofacial defect is highly reliable. Its versatility allows functional and aesthetic maxillofacial reconstruction, as well as adequate support for osteointegrated implants. It could be the flap of choice for selected maxillary and mandibular defects requiring preservation of contour and projection. doi:10.1016/j.oos.2009.06.178
O94. Reconstruction of mandibular defects – A clinical review over a 25-year period A. Eckardt *, B. Sinikovic, H. Kokemüller, S. Friedrichs, N.-C. Gellrich Dept. of Oral and Maxillofacial Surgery, Hannover Medical School, Germany Introduction: Reconstruction of trauma- or tumor-related mandibular defects is a well established surgical procedure and an essential part of the patient’s rehabilitation process. In view of many reconstructive options as far as donor site selection, timing of surgery is concerned, there still exists some controversy. Material and methods: Aim of the present clinical investigation was a retrospective review of all reconstructions of mandibular defects of various etiologies being performed at a single institution in a
Oral AbstractsPoster ListOrals ListPan. Disc. & Symp. Abs.Keynote Abs.Keynote Bios.ProgramIAOOWelcomeCommittee Listings
Oral abstracts / Oral Oncology Supplement 3 (2009) 56–122