Maxillofacial Plastic and Reconstructive Surgery

  • Volume 41
  • /
  • Pages.30.1-30.8
  • /
  • 2019
  • /
  • 2288-8101(pISSN)
  • /
  • 2288-8586(eISSN)
Korean Association of Maxillofacial Plastic and Reconstructive Surgeons (대한악안면성형재건외과학회)
권호 표지
DOI QR코드

DOI QR Code

Functional outcome predictors following mandibular reconstruction with osteocutaneous fibula free flaps: correlating early postoperative videofluoroscopic swallow studies with long-term clinical results

  • Gonzalez, Santiago R. (College of Medicine, University of Arkansas for Medical Sciences) ;
  • Hobbs, Bradley (Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences) ;
  • Vural, Emre (Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences) ;
  • Moreno, Mauricio A. (Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences)
  • Received : 2019.06.05
  • Accepted : 2019.06.24
  • Published : 2019.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Advancements in the field of microvascular surgery and the widespread adoption of microvascular surgical techniques have made the use of osteocutaneous fibula free flaps the standard of care in the surgical management of segmental mandibular defects. Although the literature possesses abundant evidence to support the effectiveness of fibula free flaps as a reconstructive method, there are relatively few studies reporting on outcomes as objectively measured by videofluoroscopic swallowing studies (VFSS). The purpose of this study is to explore the potential correlation between early postoperative VFSS and the long-term swallowing outcomes in patients who underwent mandibular reconstruction with fibula free flaps. Methods: We performed a retrospective chart review of 36 patients who underwent mandibular reconstruction with osteocutaneous fibular free flaps between 2009 and 2012. Demographics, clinical variables, VFSS data, and diet information were retrieved. Penetration and aspiration findings on VFSS, long-term oral feeding ability, and the need for gastrostomy tube were statistical endpoints correlated with postoperative clinical outcomes. Results: Thirty-six patients were reviewed (15 females and 21 males) with a mean age of 54 years (7-81). Seventeen cases were treated for malignancy. The size of the bony defect ranged from 3 to 15 cm (mean = 9 cm). The cutaneous paddle, a surrogate for soft tissue defect, ranged from 10 to 125 ㎠ (mean = 52 ㎠). A gastrostomy tube was present in patients preoperatively (n = 8), and postoperatively (n = 14). Seventeen patients had neoadjuvant exposure to radiation. Postoperative VFSS showed penetration in 13 cases (36%) and aspiration in seven (19%). Overall, 29 patients (80.6%) achieved unrestricted diet, and this was statistically correlated with age (p = 0.037), radiation therapy (p = 0.002), and preoperative gastrostomy tube (p = 0.03). The presence of penetration or aspiration on VFSS was a strong predictor for long-term unrestricted oral diet (p < 0.001). Conclusion: Early postoperative VFSS is an excellent predictor for long-term swallowing outcomes in patients undergoing mandibular reconstruction with osteocutaneous fibula free flaps.

Keywords

References

  1. Taylor GI, Miller GD, Ham FJ (1975) The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg 55(5):533-544 https://doi.org/10.1097/00006534-197505000-00002
  2. Hidalgo DA (1989) Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg 84(1):71-79 https://doi.org/10.1097/00006534-198907000-00014
  3. Chen ZW, Yan W (1983) The study and clinical application of the osteocutaneous flap of fibula. Microsurgery 4(1):11-16. https://doi.org/10.1002/micr.1920040107
  4. Urken ML (1991) Composite free flaps in mandibular reconstruction. Review of the literature. Arch Otolaryngol Head Neck Surg 117(7):724-732. https://doi.org/10.1001/archotol.1991.01870190036009
  5. Ferri J, Piot B, Ruhin B, Mercier J (1997) Advantages and limitations of the fibula free flap in mandibular reconstruction. J Oral Maxillofac Surg 55(5):440-448. https://doi.org/10.1016/S0278-2391(97)90685-6
  6. Hayden RE, Mullin DP, Patel AK (2012) Reconstruction of the segmental mandibular defect: current state of the art. Curr Opin Otolaryngol Head Neck Surg 20(4):231-236. https://doi.org/10.1097/MOO.0b013e328355d0f3
  7. Menard P, Germain MA, Kapron AM, Foussadier F, Schwabb G, Bertrand JC (1992) Mandibular reconstruction by a free peroneal transfer. Rev Stomatol Chir Maxillofac 93(2):98-105
  8. Seth R, Futran ND, Alam DS, Knott PD (2010) Outcomes of vascularized bone graft reconstruction of the mandible in bisphosphonate-related osteonecrosis of the jaws. Laryngoscope 120(11):2165-2171. https://doi.org/10.1002/lary.21062
  9. Cordeiro PG, Disa JJ, Hidalgo DA, Hu QY (1999) Reconstruction of the mandible with osseous free flaps: a 10-year experience with 150 consecutive patients. Plast Reconstr Surg 104(5):1314-1320. https://doi.org/10.1097/00006534-199910000-00011
  10. Hidalgo DA, Pusic AL (2002) Free-flap mandibular reconstruction: a 10-year follow-up study. Plast Reconstr Surg 110(2):438-449 https://doi.org/10.1097/00006534-200208000-00010
  11. Talesnik A, Markowitz B, Calcaterra T, Ahn C, Shaw W (1996) Cost and outcome of osteocutaneous free-tissue transfer versus pedicled soft-tissue reconstruction for composite mandibular defects. Plast Reconstr Surg 97(6):1167-1178. https://doi.org/10.1097/00006534-199605000-00011
  12. Wagner JD, Coleman JJ 3rd, Weisberger E et al (1998) Predictive factors for functional recovery after free tissue transfer oromandibular reconstruction. Am J Surg 176(5):430-435. https://doi.org/10.1016/S0002-9610(98)00249-9
  13. Seikaly H, Maharaj M, Rieger J, Harris J (2005) Functional outcomes after primary mandibular resection and reconstruction with the fibular free flap. J Otolaryngol 34(1):25-28 https://doi.org/10.2310/7070.2005.03060
  14. Jewer DD, Boyd JB, Manktelow RT (1989) Orofacial and mandibular reconstruction with the iliac crest free flap: a review of 60 cases and a new method of classification. Plast Reconstr Surg 84(3):391-403 https://doi.org/10.1097/00006534-198909000-00001
  15. Robbins J, Coyle J, Rosenbek J, Roecker E, Wood J (1999) Differentiation of normal and abnormal airway protection during swallowing using the penetration-aspiration scale. Dysphagia 14(4):228-232. https://doi.org/10.1007/PL00009610
  16. Urken ML, Buchbinder D, Weinberg H et al (1991) Functional evaluation following microvascular oromandibular reconstruction of the oral cancer patient: a comparative study of reconstructed and nonreconstructed patients. Laryngoscope 101(9):935-950. https://doi.org/10.1288/00005537-199109000-00004
  17. Shpitzer T, Neligan PC, Gullane PJ et al (1997) Oromandibular reconstruction with the fibular free flap. Analysis of 50 consecutive flaps. Arch Otolaryngol Head Neck Surg 123(9):939-944. https://doi.org/10.1001/archotol.1997.01900090051007
  18. Virgin FW, Iseli TA, Iseli CE et al (2010) Functional outcomes of fibula and osteocutaneous forearm free flap reconstruction for segmental mandibular defects. Laryngoscope. 120(4):663-667. https://doi.org/10.1002/lary.20791
  19. Pauloski BR, Rademaker AW, Logemann JA, Colangelo LA (1998) Speech and swallowing in irradiated and nonirradiated postsurgical oral cancer patients. Otolaryngol Head Neck Surg 118(5):616-624. https://doi.org/10.1177/019459989811800509
  20. Pauloski BR, Rademaker AW, Logemann JA et al (2004) Surgical variables affecting swallowing in patients treated for oral/oropharyngeal cancer. Head Neck 26(7):625-636. https://doi.org/10.1002/hed.20013
  21. Zuydam AC, Lowe D, Brown JS, Vaughan ED, Rogers SN (2005) Predictors of speech and swallowing function following primary surgery for oral and oropharyngeal cancer. Clin Otolaryngol 30(5):428-437. https://doi.org/10.1111/j.1365-2273.2005.01061.x