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Poster 27: Use of the Osseocutaneous Radial Forearm Free Flap for Reconstruction of the Mandible
Scientific Poster Session over the three measurement times were reflected in a low single (.305) and moderate average (.569) measure ICC. Therefore, the rater was more successful at repeating the same measurements for each image except for the FL measurement. For the set of images, the EVs tended to increase slightly over the three measurements. Conclusion: Measures of F and H by one student rater were reliable across all three measurements. In contrast, the low-moderate reliability of FL with a clear trend toward decreasing variability suggests that the rater’s reliability was low but increasing over time. Thus, Cone Beam CT imaging can be used to reliably measure F, H, and FL and to calculate the EV of the cleft. These data can be utilized by oral and maxillofacial surgeons to quantitatively assess the volume of an alveolar cleft and aid in preoperative determination of the amount of bone that will be needed to adequately graft the cleft. This will aid in appropriate selection of an autogenous graft donor site prior to surgery. References Tai C, Sutherland I, McFadden L. Prospective analysis of secondary alveolar bone grafting using computed tomography. Journal of Oral and Maxillofacial Surgery. 2000;58(11):1241-1249 Hamada Y, Kondoh T, Noguchi K, Iino M, Isono H, et al. Application of limited cone beam computed tomography to clinical assessment of alveolar bone grafting: a preliminary report. The Cleft Palate-Craniofacial Journal. 2005;42(2):128 –137kl
POSTER 27 Use of the Osseocutaneous Radial Forearm Free Flap for Reconstruction of the Mandible David L. Hirsch, DDS, MD, New York, NY (Hirsch D; Velangi A; Howell K; Levine J)
were reconstructed with the radial forearm osseocutaneous free flap. Seven patients (6 females & 1 male) were identified from 2007-08 who required segmental mandibulectomies and mandibular reconstruction. The variables examined were age, sex, diagnosis, stage, size and location of defect, mandibular height, comorbid disease, radiation, short and long term complications. Method of Data Analysis: Descriptive and quantitative statistics was undertaken. Results: Six patients in the study had Squamous cell carcinoma and one patient had clear cell carcinoma of the mandible. All patients were over 75 years of age and had multiple cormorbid diseases. Six patients had stage 4 disease while one had stage 3 disease. The average mandibular height was 2cm. The average size of the defect of the mandible ranged from 7-10 cm. Six defects were isolated to the mandibular body while one defect included the body and half of the symphysis. All patients received post-operative radiation. Two patients had local recurrences. No patients had immediate complications with the flap. Long term complications included one patient having a plate dehiscence and one patient having a fractured radius. The fractured radius occurred in the first patient and all subsequent patients had prophylactic plating without complication. Three of seven patients were able to wear lower dentures (3 of 7 patients did not wear dentures preoperatively). Conclusion: The osseocutaneous RFFF is a viable option for reconstruction of the atrophic mandible or patients with co-morbid disease where larger reconstruction may increase morbidity and mortality. All flaps were viable through post operative radiation therapy. The donor site morbidity is avoided via pre-plating of the radius which was learned after the first patient had a post-operative radius fracture. The size of the radius is variable however it is not suitable for implantation but appears to resist the deleterious effects of radiotherapy.
Presented by: Amogh Velangi, DDS, New York, NY Statement of the Problem: Vascularized free flaps are generally accepted as the reconstruction of choice for single stage head and neck reconstruction. Squamous cell carcinoma (SCC) of the mandible often necessitates segmental mandibulectomy. The most commonly utilized reconstruction option has been the microvascular free fibula flap. However, the free fibula flap is a long operation with high risk of morbidity, especially in the frail, elderly patient. In addition it is not always a viable option in the edentulous or atrophic mandible as it may cause a significant size mismatch. In cases of atrophic mandibles, or patients with comorbid disease the radial forearm free flap is a viable option for mandibular reconstruction. Materials and Methods: A retrospective chart review was performed from NYU Langone Medical center of patients requiring segmental mandibulectomies who AAOMS • 2009
References Futran N, Gal TJ, Farwell G. Radial forearm free flap. Oral Maxillofacial Surg Clin N Am. 2003;15:577-591 Shibahara T, Mohammed A, Katakura A. Long-term results of free radial forearm flap used for oral reconstruction: Functional & histological evaluation. J Oral Maxillofac Surg. 2006;64:1255-1260
POSTER 28 Nasal Reconstruction With Preoperative Tissue Expander and Forehead Flap— Our 5 Years’ Experience Ata Garajei, DMD, Tehran, Iran (Kheradmand AA; Pazoki A) Statement of the Problem: Forehead myocutaneous flap is acknowledged as the best donor site with which to reconstruct the nasal defects in cancer patients, due 83
POSTER 27 Use of the Osseocutaneous Radial Forearm Free Flap for Reconstruction of the Mandible David L. Hirsch, DDS, MD, New York, NY (Hirsch D; Velangi A; Howell K; Levine J)
were reconstructed with the radial forearm osseocutaneous free flap. Seven patients (6 females & 1 male) were identified from 2007-08 who required segmental mandibulectomies and mandibular reconstruction. The variables examined were age, sex, diagnosis, stage, size and location of defect, mandibular height, comorbid disease, radiation, short and long term complications. Method of Data Analysis: Descriptive and quantitative statistics was undertaken. Results: Six patients in the study had Squamous cell carcinoma and one patient had clear cell carcinoma of the mandible. All patients were over 75 years of age and had multiple cormorbid diseases. Six patients had stage 4 disease while one had stage 3 disease. The average mandibular height was 2cm. The average size of the defect of the mandible ranged from 7-10 cm. Six defects were isolated to the mandibular body while one defect included the body and half of the symphysis. All patients received post-operative radiation. Two patients had local recurrences. No patients had immediate complications with the flap. Long term complications included one patient having a plate dehiscence and one patient having a fractured radius. The fractured radius occurred in the first patient and all subsequent patients had prophylactic plating without complication. Three of seven patients were able to wear lower dentures (3 of 7 patients did not wear dentures preoperatively). Conclusion: The osseocutaneous RFFF is a viable option for reconstruction of the atrophic mandible or patients with co-morbid disease where larger reconstruction may increase morbidity and mortality. All flaps were viable through post operative radiation therapy. The donor site morbidity is avoided via pre-plating of the radius which was learned after the first patient had a post-operative radius fracture. The size of the radius is variable however it is not suitable for implantation but appears to resist the deleterious effects of radiotherapy.
Presented by: Amogh Velangi, DDS, New York, NY Statement of the Problem: Vascularized free flaps are generally accepted as the reconstruction of choice for single stage head and neck reconstruction. Squamous cell carcinoma (SCC) of the mandible often necessitates segmental mandibulectomy. The most commonly utilized reconstruction option has been the microvascular free fibula flap. However, the free fibula flap is a long operation with high risk of morbidity, especially in the frail, elderly patient. In addition it is not always a viable option in the edentulous or atrophic mandible as it may cause a significant size mismatch. In cases of atrophic mandibles, or patients with comorbid disease the radial forearm free flap is a viable option for mandibular reconstruction. Materials and Methods: A retrospective chart review was performed from NYU Langone Medical center of patients requiring segmental mandibulectomies who AAOMS • 2009
References Futran N, Gal TJ, Farwell G. Radial forearm free flap. Oral Maxillofacial Surg Clin N Am. 2003;15:577-591 Shibahara T, Mohammed A, Katakura A. Long-term results of free radial forearm flap used for oral reconstruction: Functional & histological evaluation. J Oral Maxillofac Surg. 2006;64:1255-1260
POSTER 28 Nasal Reconstruction With Preoperative Tissue Expander and Forehead Flap— Our 5 Years’ Experience Ata Garajei, DMD, Tehran, Iran (Kheradmand AA; Pazoki A) Statement of the Problem: Forehead myocutaneous flap is acknowledged as the best donor site with which to reconstruct the nasal defects in cancer patients, due 83