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The Free Vascularized Flap and the Flap Plate Options: Comparative Results of Reconstruction of Lateral Mandibular Defects
Author(s) -
Shpitzer Thomas,
Gullane Patrick J.,
Neligan Peter C.,
Irish Jonathan C.,
Freeman Jeremy E.,
Van den Brekel Michiel,
Gur Eyal
Publication year - 2000
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1097/00005537-200012000-00015
Subject(s) - medicine , free flap , surgery , retrospective cohort study , mandible (arthropod mouthpart) , statistical significance , swallowing , free flap reconstruction , oral cavity , dentistry , botany , biology , genus
Objectives/Hypothesis Reconstruction of the mandible and oral cavity after segmental resection is a challenging surgical problem. Although osteocutaneous free flaps are generally accepted to be optimal for reconstruction of anterior defects, the need for bony reconstruction for a pure lateral mandibular defect remains controversial. Study Design A retrospective study. Methods A retrospective comparative study of short‐ and long‐term outcomes of three different reconstruction techniques for lateral defects was performed. In total, 57 patients were included, of whom 27 had a plate and pedicled pectoralis major myocutaneous flap (PMMF group), 16 had a plate and free radial forearm flap (FRFF group), and 14 had an osteocutaneous free flap. Functionality, flap failure, and complications were scored. Results Plates had to be removed in 7 of the 27 patients in the PMMF group and 2 of the 16 in the FRFF group; none of the 14 osteocutaneous free flaps failed. The difference was of borderline statistical significance ( P = .055). Long‐term functional outcome revealed no statistically significant difference in oral deglutition ( P = .76) or in facial contour ( P = .36). Oral continence was significantly better in patients in the FRFF group (88%) as compared with the PMMF group (52%) or the osteocutaneous free flap group (43%) ( P = .02). On the other hand, the results for speech favored the osteocutaneous free flap group; 13 of 14 patients (92.9%) had a normal score compared with 12 of 16 patients (75%) in the FRFF group and 17 of 27 (63%) in the PMMF group. However, this represented a borderline statistically significant result ( P = .06). Conclusions For lateral mandibular defects, the osteocutaneous free flap is reliable and durable in the long term. However, in a selected group of patients either of the two flap‐plate options is a viable reconstructive option.