Fibula free flap in the treatment of mandibular osteoradionecrosis

Introduction: Mandibular osteoradionecrosis (mORN) is one of the major complications of radiation therapy in head and neck cancer. It is responsible for intractable pain and functional problems. Radical treatment, required in case of failure of conservative management, consists in wide resection of the necrotic tissue followed by reconstruction, notably by free flaps. The present study assessed the efficacy of reconstructive surgery by fibula free flap (FFF) in terms of pain, suppuration and functional results. Material and methods: A retrospective study recruited 5 cases of mORN treated surgically with FFF reconstruction between 2005 and 2012. For each patient, pain, resolution of suppuration, articulation, mastication and swallowing functions and recovery of oral feeding were assessed. Results: The flaps had good vitality in 4 of the 5 patients. Infection and pain resolved in all patients. Functional results were satisfactory in 4 of the 5 cases (80%). There was no recurrence of mORN. Conclusions: Micro-anastomosed FFF seems to be the method of choice for mandibular reconstruction in advanced mORN. Delayed treatment, however, seems to reduce the chances of good functional results. The precise indications for radical surgery and its timing remain to be defined, but it appears wise to decide on ever earlier radical surgery in the hope of obtaining better functional results. (C) 2015 Elsevier Masson SAS. All rights reserved.