Advertisement

Reconstruction of mandibular defects involving the central segment with fibula osteoseptocutaneous free flap following ameloblastoma resection: Patient-reported outcomes

Published:April 17, 2021DOI:https://doi.org/10.1016/j.bjps.2021.03.090

      Objectives

      Mandibular defects involving the central segment are challenging. This study analyzes the impact of defect extent and reconstruction method on quality of life (QOL) and obstructive sleep apnea (OSA).

      Materials and methods

      Twenty-nine ameloblastoma patients received segmental mandibulectomy involving the C-segment and immediate fibula free flap reconstruction were recruited. Defects: (C: 2, LC: 11, LCL: 19). Mean defect length: 8.79 cm (± 2.34). Inset: Low-single-barrel (n: 19), with secondary distraction osteogenesis (n: 8/19), high-single-barrel (n: 7), double barrel (n: 3). Patients were surveyed using University of Washington Quality of Life (UW-QOL) and Berlin risk of postoperative sleep apnea questionnaires.

      Results

      Flap failure: None. Mean follow-up: 109.6 ± 92.8 months. UW-QOL: Physical function 91.83 (± 14.92); social function 90.17 (± 17.19). No statistical difference between C, LC, and LCL was found, but C group which received low-single-barrel had the lowest score in appearance and chewing domains. In health-related QOL (HR-QOL) compared with 1 month before cancer, 69% reported best results. “Appearance” was the most important issue for the past 7 days, followed by “Chewing,” prevailing in LC and C groups that predominately reconstructed by low-single-barrel. Berlin score: 7 patients (4 LCL, 3 LC≥8 cm) were at high risk for postoperative OSA.

      Conclusion

      “Like-with-like” reconstruction with immediate endosteal dental implants yields the best results. Inset of fibula bone could affect outcomes, favoring double-barrel or single-high-barrel inset. Appearance and chewing remain the main concerns, largely, in those with low-single-barrel inset and no dental restoration. After long/extensive LCL and LC mandibulectomies, postoperative OSA warrants further investigation, and modification of resection/reconstruction techniques.

      Keywords

      To read this article in full you will need to make a payment

      References

        • Bak M.
        • Jacobson A.S.
        • Buchbinder D.
        • Urken M.L.
        Contemporary reconstruction of the mandible.
        Oral Oncol. 2010; 46: 71-76
        • Kellman R.M.
        • Gullane P.J.
        Use of the AO mandibular reconstruction plate for bridging of mandibular defects.
        Otolaryngol Clin North Am. 1987; 20: 519-533
        • Li X.
        • Zhu K.
        • Liu F.
        • Li H.
        Assessment of quality of life in giant ameloblastoma adolescent patients who have had mandible defects reconstructed with a free fibula flap.
        World J Surg Oncol. 2014; 12: 201
        • Boyd J.B.
        • Gullane P.J.
        • Rotstein L.E.
        • Brown D.H.
        • Irish J.C.
        Classification of mandibular defects.
        Plast Reconstr Surg. 1993; 92: 1266-1275
        • Pappalardo M.
        • Tsao C.K.
        • Tsang M.L.
        • Zheng J.
        • Chang Y.M.
        • Tsai C.Y.
        Long-term outcome of patients with or without osseointegrated implants after resection of mandibular ameloblastoma and reconstruction with vascularized bone graft: functional assessment and quality of life.
        J Plast Reconstr Aesthet Surg. 2018; 71: 1076-1085
        • Zhu J.
        • Yang Y.
        • Li W.
        Assessment of quality of life and sociocultural aspects in patients with ameloblastoma after immediate mandibular reconstruction with a fibular free flap.
        Br J Oral Maxillofac Surg. 2014; 52: 163-167
        • Wei F.C.
        • Seah C.S.
        • Tsai Y.C.
        • Liu S.J.
        • Tsai M.S.
        Fibula osteoseptocutaneous flap for reconstruction of composite mandibular defects.
        Plast Reconstr Surg. 1994; 93 (discussion 305-6): 294-304
        • Rogers S.N.
        • Lowe D.
        • Yueh B.
        • Weymuller Jr., E.A.
        The physical function and social-emotional function subscales of the University of Washington quality of life questionnaire.
        Arch Otolaryngol Head Neck Surg. 2010; 136: 352-357
        • Rogers S.N.
        • Gwane S.
        • Lowe D.
        • Humphris G.
        • Yueh B.
        • Weymuller E.A.
        The addition of mood and anxiety domains to the University of Washington quality of life scale.
        Head Neck. 2002; 24: 521-529
        • Netzer N.C.
        • Stoohs R.A.
        • Netzer C.M.
        • Clark K.
        • Strohl K.P.
        Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome.
        Ann Intern Med. 1999; 131: 485-491
        • Senaratna C.V.
        • Perret J.L.
        • Matheson M.C.
        • Lodge C.J.
        • Lowe A.J.
        • Cassim R.
        • Russell M.A.
        • Burgess J.A.
        • Hamilton G.S.
        • Dharmage S.C
        Validity of the Berlin questionnaire in detecting obstructive sleep apnea: a systematic review and meta-analysis.
        Sleep Med Rev. 2017; 36: 116-124
        • Chiu H.Y.
        • Chen P.Y.
        • Chuang L.P.
        • Chen N.H.
        • Tu Y.K.
        • Hsieh Y.J.
        • Wang Y.C.
        • Guilleminault C
        Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: a bivariate meta-analysis.
        Sleep Med Rev. 2017; 36: 57-70
        • Shimizu F.
        • Ooatari M.
        • Uehara M.
        • Takahashi Y.
        • Kawano K.
        Effect of concurrent mental nerve reconstruction at the same time as mandibular reconstruction using a fibula osteoseptocutaneous flap.
        Plast Reconstr Aesthet Surg. 2015; 68: 1228-1234
        • Yadav P.S.
        • Ahmad Q.G.
        • Shankhdhar V.K.
        • Nambi G.I.
        Reconstruction of oncological oro-mandibular defects with double skin paddled-free fibula flap: a prudent alternative to double flaps in resource-constrained centers.
        J Cancer Res Ther. 2012; 8: 91-95
        • Disa J.J.
        • Hidalgo D.A.
        • Cordeiro P.G.
        • Winters R.M.
        • Thaler H.
        Evaluation of bone height in osseous free flap mandible reconstruction: an indirect measure of bone mass.
        Plast Reconstr Surg. 1999; 103: 1371-1377
        • Saladin Kenneth
        Anatomy & physiology: the unity of form and function.
        7th ed. McGraw Hill Education, New York, NY2015: 324
      1. Standring Susan Borley Neil R. Gray's anatomy: the anatomical basis of clinical practice. 40th ed. Churchill Livingstone, London2008: 503-505
        • Wei Fu-Chan
        • Mardini Samir
        Flaps and reconstructive surgery.
        2nd ed. Philadelphia. Saunders/Elsevier, 2017: 276
        • Pinsolle J.
        • Michelet V.
        • Coustal B.
        • et al.
        Treatment of ameloblastoma of the jaws.
        Arch Otolaryngol Head Neck Surg. 1995; 121: 994-999
        • Becelli R.
        • Carboni A.
        • Cerulli G.
        • Perugini M.
        • Iannetti G.
        Mandibular ameloblastoma: analysis of surgical treatment carried out in 60 patients between 1977 and 1998.
        J Craniofac Surg. 2002; 13 (discussion 400): 395-400
        • Zhu J.
        • Yang Y.
        • Li W.
        Assessment of quality of life and sociocultural aspects in patients with ameloblastoma after immediate mandibular reconstruction with a fibular free flap.
        Br J Oral Maxillofac Surg. 2014; 52: 163-167
        • Li X.
        • Zhu K.
        • Liu F.
        • Li H.
        Assessment of quality of life in giant ameloblastoma adolescent patients who have had mandible defects reconstructed with a free fibula flap.
        World J Surg Oncol. 2014; 12: 201
        • Chang Y.M.
        • Wallace C.G.
        • Hsu Y.M.
        • Shen Y.F.
        • Tsai C.Y.
        • Wei F.C.
        Outcome of osseointegrated dental implants in double-barrel and vertically distracted fibula osteoseptocutaneous free flaps for segmental mandibular defect reconstruction.
        Plast Reconstr Surg. 2014; 134: 1033-1043
        • Wang L.
        • Su Y.X.
        • Liao G.Q.
        Quality of life in osteoradionecrosis patients after mandible primary reconstruction with free fibula flap.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108: 162-168
        • Moubayed S.P.
        • Barker D.A.
        • Razfar A.
        • Nabili V.
        • Blackwell K.E.
        Microvascular reconstruction of segmental mandibular defects without tracheostomy.
        Otolaryngol Head Neck Surg. 2015; 152: 250-254
        • Schrag C.
        • Chang Y.M.
        • Tsai C.Y.
        • Wei F.C.
        Complete rehabilitation of the mandible following segmental resection.
        J Surg Oncol. 2006; 94: 538-545
        • Chang Y.M.
        • Wallace C.G.
        • Hsu Y.M.
        • Shen Y.F.
        • Tsai C.Y.
        • Wei F.C.
        Outcome of osseointegrated dental implants in double-barrel and vertically distracted fibula osteoseptocutaneous free flaps for segmental mandibular defect reconstruction.
        Plast Reconstr Surg. 2014; 134: 1033-1043