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Rivista Italiana di Chirurgia Maxillo-Facciale 2002 August;13(2):69-73

language: English

Free tissue transfer in osteoradionecrosis of the mandible

Cortelazzi R. 1, Minervini C. 3, Bucaria V. 3, Turco M. 2, Urbani U. 2

1 Unit of Maxillo-Facial Surgery
2 Specialization School of Maxillo-Facial Surgery
3 Operative Unit of Plastic and Reconstructive Surgery University of Bari, Bari


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Osteoradionecrosis (ORN) of ­the ­jaws ­became fre­quent in ­the 1950s, ­when radio­ther­a­py ­for ­oral malig­nan­cies ­became a ­well-estab­lished prac­tice. Starting ­from ­the bio­log­ic fea­tures of radi­at­ed tis­sues, authors ­report ­their expe­ri­ence in ­the treat­ment of ­this com­pli­ca­tion. The ­most sig­nif­i­cant dam­age ­caused by radio­ther­a­py is hypo­vas­cu­lar­ity ­and con­se­quent hypox­ia ­and hypo­cel­lu­lar­ity of ­hard ­and ­soft tis­sues in ­the radi­at­ed ­bed. Therefore ­free tis­sue trans­fer, ­with ­its ­own ­blood sup­ply, ­has ­the ­best ­chance in ­the recon­struc­tion ­plan ­for ­advanced ­ORN of ­the ­jaws. Five cas­es of ­severe ­ORN of ­the man­dible ­are pre­sent­ed. They ­were ­all ­males, rang­ing in ­age ­from 55 to 67, ­and ­received radi­a­tion ther­a­py ­for malig­nan­cies of ­the ­oral cav­ity. A rad­i­cal ­approach ­with man­dib­u­lar resec­tion ­was per­formed in ­all cas­es ­and imme­di­ate micro­vas­cu­lar recon­struc­tion ­was ­planned. Two radi­al ­osteo-fas­cio-cuta­ne­ous ­free ­flaps, 1 scap­u­lar ­osteo-sep­to-cuta­ne­ous ­and 2 fib­u­lar ­free ­flaps, ­osteo-sep­to-cuta­ne­ous ­and ­osteo-mus­cu­lar, ­were har­vest­ed. The ­mean fol­low-up peri­od ­was ­about 30 ­months. All ­flaps sur­vived; ­there ­was com­plete remis­sion of symp­toms ­and no evi­dence of ­ORN recur­rence ­was ­observed. Complete exci­sion of ­all necrot­ic tis­sue ­and pri­mary ­free ­flap recon­struc­tion is a reli­able meth­od ­for ­the treat­ment of ­severe ­ORN of ­the ­jaws. However, to estab­lish cor­rect indi­ca­tions is man­da­to­ry in ­the man­age­ment of ­these ­patients, wheth­er a con­ser­va­tive treat­ment is ­still pos­sible or a rad­i­cal ­approach is nec­es­sary.

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