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Mandibular reconstruction in elderly patients
Author(s) -
Miyamoto Shimpei,
Higashino Takuya,
Sakuraba Minoru
Publication year - 2018
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25059
Subject(s) - medicine , soft tissue , reconstructive surgery , surgery , reconstructive surgeon , perioperative , mandible (arthropod mouthpart) , dentistry , botany , biology , genus
Background and Objectives The choice of reconstructive technique for a segmental mandibular defect in elderly patients is controversial. The aim of this study was to establish an algorithm for selecting a method of mandibular reconstruction in elderly patients. Methods We retrospectively evaluated 121 patients aged ≥65 years who underwent immediate microvascular mandibular reconstruction after oncologic resection. Patients were divided into three groups based on method of reconstruction: vascularized bone graft ( n = 49), mandibular reconstruction plate and soft tissue flap ( n = 22), and soft‐tissue flap ( n = 50). We compared perioperative outcomes among groups and investigated factors affecting the choice of reconstructive technique. Results Rates of postoperative complications did not differ significantly among groups. Mandibular reconstruction plate was indicated only for anterior mandibular defects. Soft‐tissue flap was indicated for posterior mandibular defects in patients aged ≥75 years or with a poor postoperative Eichner index. Conclusions Mandibular reconstruction plate and soft‐tissue flap can be good alternatives to vascularized bone graft in the elderly. Our algorithm uses defect type, patient age, and postoperative Eichner index to determine reconstructive technique.