Reduction of morbidity of the revascularization surgery in the management of mandibular osteoradionecrosis by basilar edge preservation

Abstract

Introduction: The chronic complications of bone free-flap revascularization surgery are mainly characterized by skin fistulization of the osteosynthesis material, which sometimes leads to reactivation of the osteoradionecrotic phenomenon. The objective of the study is to evaluate the benefit of mandibular basilar edge preservation in bone reconstructive surgery in irradiated areas performed for the treatment of advanced mandibular osteoradionecrosis.

Materials and methods: A retrospective monocentric study conducted between 2003 and 2018 including all patients undergoing revascularization surgery for the treatment of advanced osteoradionecrotic lesion with respect to the basilar margin was conducted.

Results: Eight patients (7 males and 1 female, aged 50 to 63 years) who had a marginal mandibulectomy with reconstruction by bone free flap or composite free flap were included. The stability of the reconstruction (junction native mandible/bone free flap) was achieved on average by using 1.75 [range 0-4] mini plates (Medartis® Modus 2.0, Medartis AG, Basel, Switzerland). During the follow-up (30±13 months) no chronic complication related to a dissociation of the osteosynthesis material or a reactivation of the osteoradionecrotic phenomenon were identified.

Conclusions: Despite the limited number of patients, it seems that the increase in the friction surface between the free flap and the native mandibular bone, linked to the preservation of the basilar edge, improves the primary stability of the reconstruction. This reduction in mechanical stress on osteosynthesis materials limits its use and reduces the rate of chronic complications of bone flap revascularization surgery in irradiated areas.

Keywords: Complication; Free flap; Management; Morbidity; Osteoradionecrosis; Revascularization surgery.