Case: Mandible Reconstruction in Osteoradionecrosis

Abstract

Grade II–III osteoradionecrosis of the mandible often requires advanced and carefully planned reconstructive strategy. Since irradiation does not only have an adverse effect on bone but also adjacent soft tissue components, a composite reconstruction is often needed. The current case illustrates a through and through composite mandibular defect, where several aspects need to be taken into account. First, the resection margins of necrotic bone need to be decided, after which the osteotomies of the fibula can be planned. In this case a three-piece fibula reconstruction was used to bridge the mandibular defect from angle to angle. In order to adequately reconstruct the soft tissue components, a deepithelialized skin island was designed to offer a combined inner and outer lining. Recovery was uneventful and the functional and aesthetic results satisfactory given the conditions with preoperative severely impaired tissue quality. We highly recommend an outer lining to be considered even without a preoperative external defect. The impaired elasticity of the irradiated neck usually hampers tension free closure over the vascular anastomosis.