Help with second mandible replacement after squamous

Hi @eb123 and welcome to the Head and Neck group.
A second mandible replacement isn’t something we look forward to although it does happen.
Okay now I am going to climb up on my soapbox so I can tell you about the vast experience of the surgeons and team at Mayo Rochester. And the fact that this team has mentored and taught this specific surgery to other doctors both in the US and abroad.
While likely successful with one surgery, it is possible the graph and free flap blood supply failed to heal correctly or perhaps clotted. Mayo will install a temporary Doppler device so as to listen to the pulse on the new connection for several days.
I am not a doctor but a patient who had this done in October 2020 with excellent results. All I will say is this, it’s your head. Go get the best care you can. The world famous Stanford hospital known for their vast experience in this surgery (tongue in cheek) or Mayo Clinic? Is this their mandible or yours?
Let’s get you through this second and hopefully final mandible rebuilding. Curious, which bone was used for graph first time?

Thanks for the reply. I had a fibula graft then a graft from my wrist to buccal. 2021. I was checked with a hand held doppler every morning as an inpatient for 10 days.

Also they are telling me the native mandible has osteonecrosis and may not be able to support a new graft. Who is your surgeon?

Drs Arce and Ettinger. They have vast experience in this specific surgery and have an excellent rapport with their patients.

I'm not ruling it out but (logistically) am turning over in my mind the travel burden, cost, how one recovers from major surgery in a hotel before being able to board a flight. Is there anything you can say about these things? Is there a telehealth visit available for a first consult? I have seen the travel assistance page from Mayo. Thank you for your help. I appreciate your input.

I was seven days in hospital when we left for home with a four hour drive. It wasn’t bad save for the feeding tube out my nose. Then a return two weeks later and two more appointments in the next six months. I believe some of the follow up could be handled locally. Flying with a feeding tube and cam boot might get you some looks and security might be an issue as well. There are also medical flights available with a bit of research. There are also longer term lodgings available if spending three or four weeks in Rochester would work better.
Once again I ask you to think what is of primary importance. Your life and good health. Without that, nothing else much matters.

Thanks for the reply. I'm going to have to weigh family and travel. I am glad that you have had such a good experience at Mayo! I would not be having another fibula graft (inadequate blood supply of the second fibula). I had a brief appt today with my current surgeon and we went over the CT scan and various options.

@eb123, everyone has to make their own calculus where to seek care. A few things to add to @hrhwilliam's experience and sage advice.

Requesting a second opinion at Mayo Clinic might give you peace of mind. Mayo Clinic’s goal is to provide the best care each patient needs, but does not want you to incur additional costs for evaluation or travel if there is not care to offer that is different from what you’re already receiving. When speaking with the appointment coordinator, you can also ask further questions that may help you with your decision.

How are you feeling about the options that your current surgeon described?