Mandibular Reconstruction with Vascularized Fibular Graft: Comparing Outcomes of Adjuvant Radiotherapy Versus No-Radiotherapy

Abstract

Objective: To compare the outcomes of mandibular reconstruction with vascularized fibular graft in adjuvant and nonradiotherapy Groups. Study Design: Retrospective longitudinal study. Place and Duration of Study: Plastic Surgery Department, Shifa International Hospital, Islamabad Pakistan, from 2010 to 2018. Methodology: The data of 92 patients from 2010-2018 was included. Outcomes regarding local wound complications, wound dehiscence, fistula, skin necrosis, plate exposure and bone union rate were compared in Radiated (IR) and Non-Radiated (NR) Groups. Orthopantomography (OPG) was done at one month, six months, and one-year follow-up and was reviewed by a Radiologist. Results: Ninety-two patients were included in the study, 56(60.9%) patients in the IR-Group and 36(39.1%) patients in the NRGroup. In the IR-Group, 56(60.9%) causes were intraoral squamous cell carcinoma in 51(91.0%) cases and osteosarcoma in 5(9.0%) cases. In NR-Group cases were ameloblastoma (15,41.6%), giant cell tumor (4,11.1%), craniofacial microsomia (4,11.1%), osteonecrosis (6,16.6%) and trauma (7,19. 4%). Common complications were plate exposure (2.1%), wound breakdown (10.8%) in the IR-Group, and, on the other hand, in the NR Group, wound breakdown noted in (3.2%) respectively(p=0.05). Conclusion: With our experience, adjuvant radiation is an important modality that increases survival rate and can be safely administered without any significant complications related to soft tissue and reconstructed bone.

Keywords

• Fibular graft
• Mandibular reconstruction
• Non-union
• Plate exposure
• Radiotherapy