Reconstruction of jaw and oral mucosal defects with fibular osteomyofascial flap after oncological ablation

Abstract

Abstract: PURPOSE : The use of fibular osteomyocutaneous flaps is a widely accepted technique for soft and hard tissue reconstruction in oromaxillofacial region. However, soft tissue bulk, which covers alveolar regions by the skin paddle, is not qualified for dental rehabilitation. To achieve an ideal intraoral lining, we harvested the fibular osteomyofascial flap to avoid the commonly seen embarrassment caused by fibular osteomyocutaneous flap. METHODS : Between May 2012 and May 2014, 38 patients underwent reconstruction of the maxilla and mandible using an osteomyofascial free fibula flap following oncological ablation, while 33 patients underwent reconstruction using a traditional fibular osteomyocutaneous flap. Data including the patient’s age, cause and type of defects, size of the fascial(skin) flaps, number of debulking operations, complications at both the donor and recipient sites, and the dental rehabilitation were collected and analyzed. RESULTS : All fascial flaps survived and were remucosalized. None of the patients in the osteomyofascial group required an additional debulking operation, and 84% (32/38) of the patients had conventional dentures and showed good chewing function and cosmetic results. However, only 52%(17/33) of patients in the osteomyocutaneous group underwent definitive prosthesis placement while 10 patients required debulking before dental rehabilitation. CONCLUSIONS : The fibular osteomyofascial flap, without hair-bearing but comfortable and good oral hygiene, yielded a more anatomic solution for oral mucosal defects, obviating the need for additional debulking and potentially reducing donor-site wound problems.

Key words: Fibular osteomyofascial flap, Fibular osteomyocutaneous flap, Jaw tumour ablation

CLC Number:

R782.2

FAN Song, WANG You-yuan, ZHANG Han-qing, LIN Zhao-yu, ZHONG Jiang-long, CHEN Wei-xiong, LI Qun-xing, YU Xing, LI Jin-song.. Reconstruction of jaw and oral mucosal defects with fibular osteomyofascial flap after oncological ablation[J]. China Journal of Oral and Maxillofacial Surgery, 2015, 13(6): 545-549.

References

[1] Wu YQ, Huang W, Zhang ZY, et al. Clinical outcome of dental implants placed in fibula-free flaps for orofacial reconstruction [J].Chin Med J (Engl), 2008, 121(19): 1861-1865.
[2] Lin PY, Lin KC, Jeng SF. Oromandibular reconstruction: the history, operative options and strategies, and our experience [J]. ISRN Surg, 2011, 2011: 824251.
[3] Santamaria E, Correa S, Bluebond-Langner R, et al. A shift from the osteocutaneous fibula flap to the prelaminated osteomucosal fibula flap for maxillary reconstruction[J]. Plast Reconstr Surg, 2012, 130(5): 1023-1030.
[4] Hakim SG, Kimmerle H, Trenkle T, et al. Masticatory rehabilitation following upper and lower jaw reconstruction using vascularised free fibula flap and enossal implants-19 years of experience with a comprehensive concept [J]. Clin Oral Investig, 2015, 19(2): 525-534.
[5] Nakayama B, Ikuo H, Kamei Y, et al. Successful upper alveolar reconstruction for gingival cancer using a fibular osteoadipofascial flap without osseointegrated implants [J]. Ann Plast Surg, 2005, 54(3): 323-327.
[6] Dhima M, Rieck KL, Arce K, et al. Development of stable peri-implant soft tissue and mentolabial sulcus depth with an implant-retained soft tissue conformer after osteocutaneous flap reconstruction [J]. Int J Prosthodont, 2013, 26(3): 265-267.
[7] Pigno MA. Conventional prosthetic rehabilitation after free flap reconstruction of a maxillectomy defect: a clinical report [J]. J Prosthet Dent, 2001, 86(6): 578-581.
[8] Rohner D, Bucher P, Hammer B. Prefabricated fibular flaps for reconstruction of defects of the maxillofacial skeleton: planning, technique, and long-term experience [J]. Int J Oral Maxillofac Implants, 2013, 28(5): e221-229.
[9] Yu P, Chang EI, Hanasono MM. Design of a reliable skin paddle for the fibula osteocutaneous flap: perforator anatomy revisited [J]. Plast Reconstr Surg, 2011, 128(2): 440-446.
[10] Brown JS, Shaw RJ. Reconstruction of the maxilla and midface: introducing a new classification [J]. Lancet Oncol, 2010, 11(10): 1001-1008.
[11] Jewer DD, Boyd JB, Manktelow RT, et al. Orofacial and mandibular reconstruction with the iliac crest free flap: a review of 60 cases and a new method of classification [J]. Plast Reconstr Surg, 1989, 84(3): 391-403.
[12] Pruyn JF, de Jong PC, Bosman LJ, et al. Psychosocial aspects of head and neck cancer-a review of the literature [J]. Clin Otolaryngol Allied Sci, 1986, 11(6): 469-474.
[13] Ortiz Monasterio F, Santamaría E, Morales D, et al. Reconstruction of the premaxilla: an option for mutilated bilateral clefts [J].J Craniofac Surg, 2009, 20 (Suppl 2): 1768-1770.
[14] Chiapasco M, Biglioli F, Autelitano L, et al. Clinical outcome of dental implants placed in fibula-free flaps used for the reconstruction of maxillo-mandibular defects following ablation for tumors or osteoradionecrosis [J]. Clin Oral Implants Res, 2006, 17(2): 220-228.
[15] Pfister DG, Ang KK, Brizel DM, et al. Head and neck cancers, version 2.2013. Featured updates to the NCCN guidelines [J]. J Natl Compr Canc Netw, 2013, 11(8): 917-923.