Complex Mandibular Reconstruction for Head and Neck Squamous Cell Carcinoma-The Ongoing Challenge in Reconstruction and Rehabilitation

Tomislav A Zrnc; Josip Tomic; Peter V Tomazic; Hamid Hassanzadeh; Matthias Feichtinger; Wolfgang Zemann; Philipp Metzler; Mauro Pau

doi:10.3390/cancers12113198

Complex Mandibular Reconstruction for Head and Neck Squamous Cell Carcinoma-The Ongoing Challenge in Reconstruction and Rehabilitation

Cancers (Basel). 2020 Oct 30;12(11):3198. doi: 10.3390/cancers12113198.

Authors

Tomislav A Zrnc¹, Josip Tomic¹, Peter V Tomazic², Hamid Hassanzadeh³, Matthias Feichtinger¹, Wolfgang Zemann¹, Philipp Metzler¹, Mauro Pau¹

Affiliations

¹ Department of Oral and Maxillofacial Surgery, University Hospital, Medical University of Graz Auenbruggerplatz 5, 8036 Graz, Styria, Austria.
² Department of General ORL, Head and Neck Surgery, University Hospital, Medical University of Graz, Auenbruggerplatz 26, 8036 Graz, Styria, Austria.
³ Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA 22903, USA.

Abstract

Large head and neck squamous cell carcinoma (HNSCC) tumors affecting the mandible require a versatile reconstruction to maintain form, function, and quality of life. Large defect reconstruction of soft and hard tissue in the head and neck necessitates, at best, one vascular system including various tissues by large dimensions. The subscapular flap system seems to meet these standards. A retrospective study was conducted focusing on clinical data, including an analysis of the quality of life with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaires, (QLQ-C30 and QLQ-H&N43). A total of 154 patients (122 males, 32 females; age range: 31-71 years, mean: 54.5 years) treated at our department from 1983 through to 2019 were included. Of the subscapular system free flaps (SFFs), 147 were based on the angular artery branch of the thoracodorsal pedicle (95.45%), and the remaining seven cases (4.55%) were lateral scapular border flaps. Mean mandible defect length was 7.3 cm. The mean skin paddle dimension was 86.8 cm². The most common recipient artery was the thyroid superior artery (79.22%). Major postoperative complications occurred in 13 patients (8.44%). This study confirms that SFFs offer excellent soft and hard tissue quality, component independence, a large arc of rotation length, and a large gauge of pedicle, making them the gold standard for the reconstruction of large composite defects of mandibular HNSCC tumors.

Keywords: EORTC QLQ-C30; EORTC QLQ-H& HNSCC; N43; free flap; head and neck squamous cell carcinoma; mandible composite reconstruction; prosthetic rehabilitation; quality of life; surgical treatment.