Microvascular Free Tissue Transfer for Treatment of Osteoradionecrosis of the Maxilla

Head and neck tumors often require radiotherapy as part of the treatment protocol. Although it improves the survival rate in cancer patients, it may cause osteoradionecrosis, especially in the mandible and maxilla. Twelve patients with osteoradionecrosis of the maxilla were treated with microsurgical free tissue transplantations between April of 1996 and August of 2002. There were 10 male and two female patients, with a mean age of 60.2 years. The mean radiotherapy dose was 6674 cGy. The radiation dose could not be traced in three patients because radiotherapy was performed elsewhere. Radical sequestrectomy, soft-tissue débridement, and pathologic proof of no tumor recurrence were performed before microsurgical reconstruction. Free flaps used included the following: anterolateral thigh (n = 7), radial forearm (n = 2), rectus femoris musculocutaneous (n = 2), and supracondylar chimeric (n = 1) flaps. All flaps survived completely and reconstruction succeeded. During a mean 25-month follow-up period, ectropion, plate exposure, and mild infection were encountered in three patients and treated successfully. Radical débridement and obliteration of dead space with well-vascularized tissue are essential for successful treatment of maxillary osteoradionecrosis. The anterolateral thigh flap is most versatile for almost all types of soft-tissue defect reconstruction in the head and neck region.

[1]  F. Wei,et al.  Clinical Experience of 1284 Free Anterolateral Thigh Flaps , 2002, Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V....

[2]  S. Jeng,et al.  Technique and Strategy in Anterolateral Thigh Perforator Flap Surgery, Based on an Analysis of 15 Complete and Partial Failures in 439 Cases , 2002, Plastic and reconstructive surgery.

[3]  Hung-Chi Chen,et al.  Have We Found an Ideal Soft‐Tissue Flap? An Experience with 672 Anterolateral Thigh Flaps , 2002, Plastic and reconstructive surgery.

[4]  M. Cheng,et al.  Osteoradionecrosis of the Mandible after Oromandibular Cancer Surgery , 2002, Plastic and reconstructive surgery.

[5]  M. Cheng,et al.  Combined Anterolateral Thigh Flap and Vascularized Fibula Osteoseptocutaneous Flap in Reconstruction of Extensive Composite Mandibular Defects , 2002, Plastic and reconstructive surgery.

[6]  A. Goss,et al.  Hyperbaric oxygen in the therapeutic management of osteoradionecrosis of the facial bones. , 2000, International journal of oral and maxillofacial surgery.

[7]  S. Jisander,et al.  Treatment of mandibular osteoradionecrosis by cancellous bone grafting. , 1999, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[8]  S. Hao,et al.  Systematic Management of Osteoradionecrosis in the Head and Neck , 1999, The Laryngoscope.

[9]  E. Santamaria,et al.  Fibula Osteoseptocutaneous Flap for Reconstruction of Osteoradionecrosis of the Mandible , 1998, Plastic and reconstructive surgery.

[10]  P. Cordeiro,et al.  Resection and immediate microvascular reconstruction in the management of osteoradionecrosis of the mandible , 1997, Head & neck.

[11]  M. Singer,et al.  Experience With Segmental Reconstruction of the Radiated Mandible With Alloplastic Prostheses , 1997, The Laryngoscope.

[12]  H. Sailer,et al.  Mandibular reconstruction with full thickness calvarial bone and temporal muscle flap. , 1996, The British journal of oral & maxillofacial surgery.

[13]  D. Bakker,et al.  Hyperbaric oxygen treatment of osteoradionecrosis of the mandible. Experience in 29 patients. , 1995, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[14]  P. Cianci,et al.  Adjunctive hyperbaric oxygen therapy in the treatment of thermal burns: a review. , 1994, Burns : journal of the International Society for Burn Injuries.

[15]  P. Losapio,et al.  [Reconstruction of extensive mandibular defects with the use of Osteo-Mesh and a bone graft. A preliminary report]. , 1989, Minerva stomatologica.

[16]  G. Widmark,et al.  Osteoradionecrosis of the jaws. , 1989, International journal of oral and maxillofacial surgery.

[17]  J. Frich,et al.  A study of factors contributing to the development of osteoradionecrosis of the jaws. , 1988, The Journal of prosthetic dentistry.

[18]  R. Marx,et al.  Studies in the radiobiology of osteoradionecrosis and their clinical significance , 1987 .

[19]  J. Schweiger.  Oral complications following radiation therapy: a five-year retrospective report. , 1987, The Journal of prosthetic dentistry.

[20]  W. Panje,et al.  The free greater omental flap for treatment of mandibular osteoradionecrosis. , 1987, Archives of otolaryngology--head & neck surgery.

[21]  J. Epstein,et al.  Osteoradionecrosis: clinical experience and a proposal for classification. , 1987, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[22]  S. Baker.  Management of osteoradionecrosis of the mandible with myocutaneous flaps , 1983, Journal of surgical oncology.

[23]  R. Marx.  Osteoradionecrosis: a new concept of its pathophysiology. , 1983, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[24]  T. K. Hunt,et al.  Regulation of wound-healing angiogenesis-effect of oxygen gradients and inspired oxygen concentration. , 1981, Surgery.

[25]  K. Fu,et al.  Osteonecrosis in patients irradiated for head and neck carcinoma , 1981, Cancer.

[26]  J. Herson,et al.  Radiation necrosis of the mandible: a 10 year study. Part I. Factors influencing the onset of necrosis. , 1980, International journal of radiation oncology, biology, physics.

[27]  S. Zimmerman,et al.  The relationship between dental disease and radiation necrosis of the mandible. , 1980, Oral surgery, oral medicine, and oral pathology.

[28]  J. Beumer,et al.  Radiation therapy of the oral cavity: sequelae and management, part 2. , 1979, Head & neck surgery.

[29]  J. Beumer,et al.  Radiation therapy of the oral cavity: sequelae and management, part 1. , 1979, Head & neck surgery.

[30]  G. Fletcher,et al.  Osteonecrosis in patients treated with definitive radiotherapy for squamous cell carcinomas of the oral cavity and naso-and oropharynx. , 1976, Radiology.

[31]  E. Mainous,et al.  The treatment of radiation necrosis with hyperbaric oxygen (OHP) , 1976, Cancer.

[32]  G. B. Hart,et al.  Osteoradionecrosis of the Mandible: Treatment With Hyperbaric Oxygen , 1975 .

[33]  T. K. Hunt,et al.  The effect of varying ambient oxygen tensions on wound metabolism and collagen synthesis. , 1972, Surgery, gynecology & obstetrics.

[34]  J. B. Drane,et al.  Management of problems of the teeth and jaw in patients undergoing irradiation , 1972 .

[35]  T. Nakatsuka,et al.  Surgical treatment of mandibular osteoradionecrosis: versatility of the scapular osteocutaneous flap. , 1996, Scandinavian journal of plastic and reconstructive surgery and hand surgery.

[36]  J. Blanc,et al.  [Current trends in the treatment of mandibular osteoradionecrosis. Use of a sternocleidomastoid osteomyocutaneous flap]. , 1985, Revue de stomatologie et de chirurgie maxillo-faciale.