Download PDF
J Reconstr Microsurg 2013; 29(01): 005-014
DOI: 10.1055/s-0032-1326731
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Osteocutaneous Free Tissue Transplantation for Mandibular Osteoradionecrosis

Shamir P. Chandarana
1   Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan
2   Department of Otolaryngology–Head and Neck Surgery, University of Calgary, Calgary, Alberta, Canada
,
Eric J.P. Chanowski
1   Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan
,
Keith A. Casper
3   Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio
,
Gregory T. Wolf
1   Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan
,
Carol R. Bradford
1   Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan
,
Francis P. Worden
4   Department of Internal Medicine–Hematology/Oncology, University of Michigan Health System, Ann Arbor, Michigan
,
Avraham Eisbruch
5   Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, Michigan
,
Douglas B. Chepeha
1   Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan
› Author Affiliations
Further Information

Publication History

12 October 2011

15 May 2012

Publication Date:
23 October 2012 (online)

    Permissions and Reprints

Abstract

Objective To describe the success rate, complications, and functional outcomes of patients who are treated with osteocutaneous free tissue transplantation for grade 4 mandibular osteoradionecrosis (ORN).

Design Retrospective case series.

Setting Tertiary care academic medical center.

Patients Twelve patients (8 males, 4 females; mean age, 57.6 years) with grade 4 mandibular ORN. Three patients (25%) had a history of primary radiotherapy, two (17%) had previous concurrent chemoradiation, and seven (58%) had undergone postoperative adjuvant radiotherapy. Ten patients (83%) had previous major ablative surgery to treat the primary tumor and five (50%) had been reconstructed with a free tissue transplant prior to the onset of ORN.

Interventions All patients underwent reconstruction with an osteocutaneous free tissue transplant for grade 4 mandibular ORN between 1999 and 2006.

Main Outcome Measures Successful treatment of mandibular ORN; major, minor, and late complications; gastrostomy tube (G-tube) dependence; speech and swallowing scores.

Results Grade 4 mandibular ORN was successfully treated in eight (73%) evaluable patients. One patient (8%) died of a second primary tumor before the 12-month assessment. Eight patients (67%) had a major complication, three (25%) had a minor complication, and nine (75%) had a late complication. Three of the five G-tube– dependent patients prior to mandibular reconstruction were able to discontinue the use of their G-tube. Seven of the eight successfully treated patients maintained their nutrition by mouth. Median “range of liquids” score was 6/6 (range, 4 to 6). Median “range of solids” score was 4/6 (range, 3 to 6). Median “understandability of speech” score was 4/5 (range, 2 to 5).

Conclusions Grade 4 mandibular ORN was treated successfully with an osteocutaneous free tissue transfer in eight evaluable patients (73%). In successfully treated patients, median speech/swallowing scores were highly functional, but the remaining radiated soft tissue resulted in higher local wound complications and a modified diet.

Keywords

osteoradionecrosis - reconstructive surgical procedures - mandible - surgical flaps - head and neck neoplasms
 

  • References

  • 1 Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995; 31: 1341-1346
    CrossrefPubMedGoogle Scholar
  • 2 Curi MM, Oliveira dos Santos M, Feher O, Faria JC, Rodrigues ML, Kowalski LP. Management of extensive osteoradionecrosis of the mandible with radical resection and immediate microvascular reconstruction. J Oral Maxillofac Surg 2007; 65: 434-438
    CrossrefPubMedGoogle Scholar
  • 3 Jansma J, Vissink A, Spijkervet FK , et al. Protocol for the prevention and treatment of oral sequelae resulting from head and neck radiation therapy. Cancer 1992; 70: 2171-2180
    CrossrefPubMedGoogle Scholar
  • 4 Madrid C, Abarca M, Bouferrache K. Osteoradionecrosis: an update. Oral Oncol 2010; 46: 471-474
    CrossrefPubMedGoogle Scholar
  • 5 Annane D, Depondt J, Aubert P , et al. Hyperbaric oxygen therapy for radionecrosis of the jaw: a randomized, placebo-controlled, double-blind trial from the ORN96 study group. J Clin Oncol 2004; 22: 4893-4900
    Google Scholar
  • 6 Coskunfirat OK, Wei FC, Huang WC, Cheng MH, Yang WG, Chang YM. Microvascular free tissue transfer for treatment of osteoradionecrosis of the maxilla. Plast Reconstr Surg 2005; 115: 54-60
    PubMedGoogle Scholar
  • 7 Shaha AR, Cordeiro PG, Hidalgo DA , et al. Resection and immediate microvascular reconstruction in the management of osteoradionecrosis of the mandible. Head Neck 1997; 19: 406-411
    CrossrefPubMedGoogle Scholar
  • 8 Hao SP, Chen HC, Wei FC, Chen CY, Yeh AR, Su JL. Systematic management of osteoradionecrosis in the head and neck. Laryngoscope 1999; 109: 1324-1327 , discussion 1327–1328
    CrossrefPubMedGoogle Scholar
  • 9 Jacobson AS, Buchbinder D, Hu K, Urken ML. Paradigm shifts in the management of osteoradionecrosis of the mandible. Oral Oncol 2010; 46: 795-801
    CrossrefPubMedGoogle Scholar
  • 10 Gal TJ, Yueh B, Futran ND. Influence of prior hyperbaric oxygen therapy in complications following microvascular reconstruction for advanced osteoradionecrosis. Arch Otolaryngol Head Neck Surg 2003; 129: 72-76
    CrossrefPubMedGoogle Scholar
  • 11 Andrade WN, Lipa JE, Novak CB , et al. Comparison of reconstructive procedures in primary versus secondary mandibular reconstruction. Head Neck 2008; 30: 341-345
    CrossrefPubMedGoogle Scholar
  • 12 Hirsch DL, Bell RB, Dierks EJ, Potter JK, Potter BE. Analysis of microvascular free flaps for reconstruction of advanced mandibular osteoradionecrosis: a retrospective cohort study. J Oral Maxillofac Surg 2008; 66: 2545-2556
    CrossrefPubMedGoogle Scholar
  • 13 Chang DW, Oh HK, Robb GL, Miller MJ. Management of advanced mandibular osteoradionecrosis with free flap reconstruction. Head Neck 2001; 23: 830-835
    CrossrefPubMedGoogle Scholar
  • 14 Alam DS, Nuara M, Christian J. Analysis of outcomes of vascularized flap reconstruction in patients with advanced mandibular osteoradionecrosis. Otolaryngol Head Neck Surg 2009; 141: 196-201
    CrossrefPubMedGoogle Scholar
  • 15 Sandel IV HD, Davison SP. Microsurgical reconstruction for radiation necrosis: an evolving disease. J Reconstr Microsurg 2007; 23: 225-230
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Militsakh ON, Wallace DI, Kriet JD, Tsue TT, Girod DA. The role of the osteocutaneous radial forearm free flap in the treatment of mandibular osteoradionecrosis. Otolaryngol Head Neck Surg 2005; 133: 80-83
    CrossrefPubMedGoogle Scholar
  • 17 Chepeha DB, Khariwala SS, Chanowski EJ , et al. Thoracodorsal artery scapular tip autogenous transplant: vascularized bone with a long pedicle and flexible soft tissue. Arch Otolaryngol Head Neck Surg 2010; 136: 958-964
    CrossrefPubMedGoogle Scholar
  • 18 Chepeha DB, Teknos TN, Shargorodsky J , et al. Rectangle tongue template for reconstruction of the hemiglossectomy defect. Arch Otolaryngol Head Neck Surg 2008; 134: 993-998
    CrossrefPubMedGoogle Scholar
  • 19 Chepeha DB, Sacco AG, Erickson VR , et al. Oropharyngoplasty with template-based reconstruction of oropharynx defects. Arch Otolaryngol Head Neck Surg 2009; 135: 887-894
    CrossrefPubMedGoogle Scholar
  • 20 List MA, Ritter-Sterr C, Lansky SB. A performance status scale for head and neck cancer patients. Cancer 1990; 66: 564-569
    CrossrefPubMedGoogle Scholar
  • 21 Ang E, Black C, Irish J , et al. Reconstructive options in the treatment of osteoradionecrosis of the craniomaxillofacial skeleton. Br J Plast Surg 2003; 56: 92-99
    CrossrefPubMedGoogle Scholar
  • 22 Baumann DP, Yu P, Hanasono MM, Skoracki RJ. Free flap reconstruction of osteoradionecrosis of the mandible: A 10-year review and defect classification. Head Neck 2011; 33: 800-807
    CrossrefPubMedGoogle Scholar