J Reconstr Microsurg 2020; 36(01): 021-027
DOI: 10.1055/s-0039-1694044
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Challenging the Orthodoxy of Mandibular Reconstructions Comparing Functional Outcomes in Osseous versus Soft Tissue Reconstructions of the Posterolateral Mandible

1   Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom
,
Jonothan Clibbon
1   Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom
,
Martin Heaton
1   Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom
,
Narayanan Viswanathan
1   Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom
,
Hyder Ridha
1   Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom
,
Richard James
1   Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom
› Author Affiliations
Funding None.
Further Information

Publication History

16 February 2019

23 June 2019

Publication Date:
09 August 2019 (online)

Abstract

Background Appropriate reconstruction of the posterolateral mandible remains controversial. Both osseous and soft tissues are vital components for an overall successful outcome and are often combined in complex defects. Their respective effect on oromandibular function in the reconstruction of different degrees of mandibular defects has been less evaluated. This study aimed to compare patient-perceived oromandibular function in osseous and soft tissue-only reconstructions following posterolateral mandibular defects, defined as limited or extended.

Patients and Methods A 10-year retrospective review of consecutive patients undergoing mandibular reconstructions of the posterolateral mandible were identified. Limited defects were defined as reaching from the ipsilateral parasymphysis to anterior of the coronoid (sparing insertion of muscles of mastication). Extended defects were defined as reaching from the ipsilateral parasymphysis to posterior of the coronoid (sacrificing the muscle insertions). Functional outcomes were assessed using the University of Washington Quality of Life questionnaire, version 4.

Results A total of 163 patients were identified, of which 41 patients had the particular posterolateral mandibular resections sought after. In 23 limited resections, there was no difference in functional outcome between osseous and soft tissue-only reconstructions. In 18 patients undergoing extended resections, osseous reconstructions demonstrated significantly better outcomes (p = 0.011). There were no significant differences in patient demographics between the groups.

Conclusion Our study highlights the interest of soft tissue-only reconstructions of the posterolateral mandible. Limited resections seem not to benefit from complex osseous reconstruction for adequate function. Conversely, there is a noteworthy positive impact on functional outcomes in extended posterolateral mandibulectomies reconstructed with osseous tissue, compared with soft tissue only. Although a larger study is needed to identify a stronger relationship, these preliminary results could aid reconstructive decisions, particularly when considering patient morbidity.

 
  • References

  • 1 Wong CH, Wei FC. Microsurgical free flap in head and neck reconstruction. Head Neck 2010; 32 (09) 1236-1245
  • 2 Ueda N, Imai Y, Sugiura T. , et al. Three-dimensional finite element analysis of the biomechanical strength of the mandible after marginal resection. J Oral Maxillofac Surg 2014; 72 (09) (Suppl): e198
  • 3 Cordeiro PG, Disa JJ, Hidalgo DA, Hu QY. Reconstruction of the mandible with osseous free flaps: a 10-year experience with 150 consecutive patients. Plast Reconstr Surg 1999; 104 (05) 1314-1320
  • 4 Hidalgo DA, Pusic AL. Free-flap mandibular reconstruction: a 10-year follow-up study. Plast Reconstr Surg 2002; 110 (02) 438-449 , discussion 450–451
  • 5 Brown JS, Lowe D, Kanatas A, Schache A. Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years. Br J Oral Maxillofac Surg 2017; 55 (02) 113-126
  • 6 Grohmann I, Raith S, Mücke T. , et al. Biomechanical loading test on reconstructed mandibles with fibular, iliac crest or scapula graft: a comparative study. Br J Oral Maxillofac Surg 2015; 53 (08) 741-747
  • 7 Urken ML, Weinberg H, Vickery C, Buchbinder D, Lawson W, Biller HF. Oromandibular reconstruction using microvascular composite free flaps. Report of 71 cases and a new classification scheme for bony, soft-tissue, and neurologic defects. Arch Otolaryngol Head Neck Surg 1991; 117 (07) 733-744
  • 8 Boyd JB, Gullane PJ, Rotstein LE, Brown DH, Irish JC. Classification of mandibular defects. Plast Reconstr Surg 1993; 92 (07) 1266-1275
  • 9 Hidalgo DA. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg 1989; 84 (01) 71-79
  • 10 Hidalgo DA. Aesthetic improvements in free-flap mandible reconstruction. Plast Reconstr Surg 1991; 88 (04) 574-585 , discussion 586–587
  • 11 Moubayed SP, L'Heureux-Lebeau B, Christopoulos A. , et al. Osteocutaneous free flaps for mandibular reconstruction: systematic review of their frequency of use and a preliminary quality of life comparison. J Laryngol Otol 2014; 128 (12) 1034-1043
  • 12 Rossi AC, Freire AR, Prado FB, Asprino L, Correr-Sobrinho L, Caria PHF. Photoelastic and finite element analyses of occlusal loads in mandibular body. Anat Res Int 2014; 2014: 174028
  • 13 Paleri V, Wight RG, Silver CE. , et al. Comorbidity in head and neck cancer: a critical appraisal and recommendations for practice. Oral Oncol 2010; 46 (10) 712-719
  • 14 Rogers SN, Gwanne S, Lowe D, Humphris G, Yueh B, Weymuller Jr EA. The addition of mood and anxiety domains to the University of Washington quality of life scale. Head Neck 2002; 24 (06) 521-529
  • 15 Lowe D, Rogers SN. University of Washington Quality of Life Questionnaire. The University of Washington questionnaire. Available at: http://www.headandneckcancer.co.uk/professionals/quality-life/qol-questionnaires/university-washington . Accessed October 16, 2018
  • 16 Djan R, Penington A. A systematic review of questionnaires to measure the impact of appearance on quality of life for head and neck cancer patients. J Plast Reconstr Aesthet Surg 2013; 66 (05) 647-659
  • 17 Hanasono MM, Zevallos JP, Skoracki RJ, Yu P. A prospective analysis of bony versus soft-tissue reconstruction for posterior mandibular defects. Plast Reconstr Surg 2010; 125 (05) 1413-1421
  • 18 Mizukami T, Hyodo I, Fukamizu H, Mineta H. Reconstruction of lateral mandibular defect: a comparison of functional and aesthetic outcomes of bony reconstruction vs soft tissue reconstruction - long-term follow-up. Acta Otolaryngol 2013; 133 (12) 1304-1310
  • 19 Talesnik A, Markowitz B, Calcaterra T, Ahn C, Shaw W. Cost and outcome of osteocutaneous free-tissue transfer versus pedicled soft-tissue reconstruction for composite mandibular defects. Plast Reconstr Surg 1996; 97 (06) 1167-1178
  • 20 Wilson KM, Rizk NM, Armstrong SL, Gluckman JL. Effects of hemimandibulectomy on quality of life. Laryngoscope 1998; 108 (10) 1574-1577
  • 21 Dimovska EO, Clibbon JJ, Moncrieff MD, Heaton MJ, Figus A. Microsurgical reconstructions for head and neck cancers in elderly aged >80 years: an analysis of surgical outcomes and quality of life. Ann Surg Oncol 2016; 23 (05) 1684-1692
  • 22 Urken ML, Buchbinder D, Weinberg H. , et al. Functional evaluation following microvascular oromandibular reconstruction of the oral cancer patient: a comparative study of reconstructed and nonreconstructed patients. Laryngoscope 1991; 101 (09) 935-950
  • 23 Jeannon JP, Orabi A, McGurk M, Ng R, Roblin P, Simo R. Reconstruction of segmental hemi-mandibular defects using soft tissue flaps in patients with severe comorbidity and advanced head and neck cancer. J Egypt Natl Canc Inst 2008; 20 (04) 342-347
  • 24 Mosahebi A, Chaudhry A, McCarthy CM. , et al. Reconstruction of extensive composite posterolateral mandibular defects using nonosseous free tissue transfer. Plast Reconstr Surg 2009; 124 (05) 1571-1577
  • 25 Kroll SS, Robb GL, Miller MJ, Reese GP, Evans GR. Reconstruction of posterior mandibular defects with soft tissue using the rectus abdominis free flap. Br J Plast Surg 1998; 51 (07) 503-507
  • 26 Komisar A. The functional result of mandibular reconstruction. Laryngoscope 1990; 100 (04) 364-374