Autologous freeze-treated bone for mandibular reconstruction after malignant tumor resection: a study of 72 patients

Giulio Cantu, Gabriella Bimbi, Sarah Colombo, Stefano Riccio, Massimo Squadrelli, Umberto Napoli, Madia Pompilio

Research output: Contribution to journalArticle

Abstract

Objective: The aim of the study was to assess the possibility of mandibular reconstruction with autologous freeze-treated bone after mandibular resection for malignant tumors. Patients: The medical records of 72 consecutive patients surgically treated with segmental mandibular resection and reconstruction with autologous freeze-treated mandible were reviewed. Results: All tumors were in stage T4a for deep infiltration of the mandible. Soft tissues were reconstructed with a direct mucosal closure (4 cases), with a pedicled pectoralis flap (17 cases), and with a forearm fasciocutaneous free flap without or with radial periosteum (18 and 33 cases). Four patients presented with a recurrence after previous surgery and radiotherapy, and 26 patients underwent postoperative radiotherapy. We resected the mental arch in 35 cases and the lateral mandible in 37 cases. Forty-one patients (56.9%) retained their autologous mandibular graft. In 31 cases, the bone graft was removed for mucosal dehiscence and bone infection. Lateral resections achieved a better success rate than anterior resections (75.7% vs 37.1%). The pedicled pectoralis flap achieved the worse success rate (35.3%) in comparison with forearm fasciocutaneous flap (66.7%). Postoperative radiotherapy decreased the success rate (40.0% vs 69.1%). Conclusions: Mandibular reconstruction with autologous frozen bone is an interesting alternative to more sophisticated methods for patients with oral cancer involving the bone. It is time and cost sparing in comparison to fibula or iliac crest flaps. However, in spite of any intraoral reconstruction, the success rate is not stirring. In our opinion, this type of mandibular reconstruction must be reserved to patients with lateral tumors, with poor prognosis, or severe comorbidities not allowing more complex bone reconstruction.

Original languageEnglish
Pages (from-to)383-389
Number of pages7
JournalAmerican Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume30
Issue number6
DOIs
Publication statusPublished - Nov 2009

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Mandibular Reconstruction
Bone and Bones
Mandible
Neoplasms
Surgical Flaps
Radiotherapy
Forearm
Transplants
Bone Neoplasms
Periosteum
Fibula
Free Tissue Flaps
Mouth Neoplasms
Medical Records
Comorbidity
Costs and Cost Analysis
Recurrence
Infection

ASJC Scopus subject areas

  • Otorhinolaryngology

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Autologous freeze-treated bone for mandibular reconstruction after malignant tumor resection : a study of 72 patients. / Cantu, Giulio; Bimbi, Gabriella; Colombo, Sarah; Riccio, Stefano; Squadrelli, Massimo; Napoli, Umberto; Pompilio, Madia.

In: American Journal of Otolaryngology - Head and Neck Medicine and Surgery, Vol. 30, No. 6, 11.2009, p. 383-389.

Research output: Contribution to journalArticle

Cantu, Giulio ; Bimbi, Gabriella ; Colombo, Sarah ; Riccio, Stefano ; Squadrelli, Massimo ; Napoli, Umberto ; Pompilio, Madia. / Autologous freeze-treated bone for mandibular reconstruction after malignant tumor resection : a study of 72 patients. In: American Journal of Otolaryngology - Head and Neck Medicine and Surgery. 2009 ; Vol. 30, No. 6. pp. 383-389.
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abstract = "Objective: The aim of the study was to assess the possibility of mandibular reconstruction with autologous freeze-treated bone after mandibular resection for malignant tumors. Patients: The medical records of 72 consecutive patients surgically treated with segmental mandibular resection and reconstruction with autologous freeze-treated mandible were reviewed. Results: All tumors were in stage T4a for deep infiltration of the mandible. Soft tissues were reconstructed with a direct mucosal closure (4 cases), with a pedicled pectoralis flap (17 cases), and with a forearm fasciocutaneous free flap without or with radial periosteum (18 and 33 cases). Four patients presented with a recurrence after previous surgery and radiotherapy, and 26 patients underwent postoperative radiotherapy. We resected the mental arch in 35 cases and the lateral mandible in 37 cases. Forty-one patients (56.9{\%}) retained their autologous mandibular graft. In 31 cases, the bone graft was removed for mucosal dehiscence and bone infection. Lateral resections achieved a better success rate than anterior resections (75.7{\%} vs 37.1{\%}). The pedicled pectoralis flap achieved the worse success rate (35.3{\%}) in comparison with forearm fasciocutaneous flap (66.7{\%}). Postoperative radiotherapy decreased the success rate (40.0{\%} vs 69.1{\%}). Conclusions: Mandibular reconstruction with autologous frozen bone is an interesting alternative to more sophisticated methods for patients with oral cancer involving the bone. It is time and cost sparing in comparison to fibula or iliac crest flaps. However, in spite of any intraoral reconstruction, the success rate is not stirring. In our opinion, this type of mandibular reconstruction must be reserved to patients with lateral tumors, with poor prognosis, or severe comorbidities not allowing more complex bone reconstruction.",
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