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Laryngoscope. 2014 Jun;124(6):1329-35. doi: 10.1002/lary.24383. Epub 2013 Oct 1.

Changing indications for maxillomandibular reconstruction with osseous free flaps: a 17-year experience with 620 consecutive cases at UCLA and the impact of osteoradionecrosis.

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  • 1Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.

Abstract

OBJECTIVES/HYPOTHESIS:

To characterize the changing indications for osseous free flaps in maxillomandibular reconstruction at our institution.

STUDY DESIGN:

Retrospective chart review.

METHODS:

Database review of patients who underwent free-flap reconstruction of the jaws using vascularized bone-containing free tissue transfer from 1995 to 2012 at the University of California Los Angeles (UCLA).

RESULTS:

A total of 620 osseous free flaps were performed. The most common indications for surgery were squamous cell carcinoma (n = 442) and osteoradionecrosis (ORN)) of the mandible (n = 73). There were no significant differences in 90-day perioperative complication, flap viability, or mortality rates between any of the indications for surgery. Patients older than 60 years had a higher rate of major perioperative complication (P = 0.0028). ORN cases represented 1.3% ± 1.2% of surgical volume from 1995 to 2000, 8.7% ± 1.8% from 2001 to 2006, and 17.5% ± 2.2% from 2007 to 2012 (P <0.0001). Among cases of ORN, 95.8% of patients had radiation therapy completed at centers outside of our hospital system. For patients with ORN, there was an average interval of 8.7 ± 8.0 years from initiation of radiotherapy to the date of mandibulectomy (range 1-37 years).

CONCLUSION:

The incidence of ORN as an indication for free-flap reconstruction has increased at our institution in recent years. This may reflect an increasing need for the surgical management of medically refractory ORN, a rising awareness or prevalence of ORN overall, and/or increasing comfort with free flaps as a treatment for ORN. Patients who undergo free-flap surgery for ORN do not have greater risks of 90-day perioperative complications or differences in free-flap viability as compared to patients who undergo free-flap reconstruction for other indications.

LEVEL OF EVIDENCE:

2b.

KEYWORDS:

Osseous free flap; composite resection; fibula free flap; maxillomandibular reconstruction; microvascular reconstruction; osteoradionecrosis; segmental mandibulectomy; vascularized bone-containing free tissue transfer

PMID:
23946198
DOI:
10.1002/lary.24383
[PubMed - indexed for MEDLINE]
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