Connect
Mandible Reconstruction with Fibula Free Flap. Is this an option?
In cases of radiation to the jaw resulting in Osteoradionecrosis (radiation bone death) or Ameloblastoma or similar growths on the mandible, reconstruction surgery is sometimes recommended. The mandible (lower jaw bone) has become constantly infected, weak causing pain, teeth failing, habitually sore or troublesome, after radiation therapy often years in the past. Your doctors or dentists may be suggesting surgery. Ameloblastoma patients sometimes have little choice due to the tumor often embedded in the mandible itself. While there are options to mandible reconstruction, what works very well is replacement of the infected section with your own transplanted bone and tissue.
When replacing a mandible section with harvested bone, the bone section selected will have the blood supply attached (free flap) which will be reconnected to an existing artery to keep the bone alive. This allows for healing and complete attachment to the existing mandible. Mayo Clinic Rochester, one of only a few places in the world that perform this type of surgery, uses either a section of bone from the Fibula or from the hip or shoulder area. The Fibula is a flexible bone in the lower leg which is non-weight bearing and won’t be particularly missed.
Dr’s Arce and Ettinger among others in the Oral and Maxillofacial Surgery group removed a section of my left fibula and surrounding tissue and fit that precisely into my left mandible along with peg inserts to support prosthetic teeth. 3-D models of my jaw were worked up and used as templates prior to surgery so that everything fit as necessary. The entire procedure for my end was about six hours of happy sleep. Recovery was a bit longer of roughly a week before I was released from hospital.
I had a feeding tube installed for nutrition and medication as well as a CAM-boot on my leg to promote healing. The feeding tube was removed after three weeks whilst the CAM-boot was probably gone after two. The healing while not comfortable was certainly manageable and I returned to work (restricted mostly to a desk) about four weeks after surgery.
Healing continued with return visits to Mayo for teeth prosthesis and to have my trach closed, which it did not do on it’s own because things like that happen to me. Nine months out I was eating corn on the cob for the first time in many years and walking without issue, miles per day. Now two years out, other than meticulously cleaning my teeth thrice-daily, I really have no issues with eating, talking, or walking. The healing was certainly much faster than the cancer treatments that proceeded this adventure twenty years prior.
Has anyone else been troubled by teeth or jaw since radiation or surgery? Has Mandible Reconstruction been considered?
Like
Helpful
HugInterested in more discussions like this? Go to the Head & Neck Cancer Support Group.
Connect
So you didn't have your upper teeth replaced, I have no teeth except a few on the bottom that aren't any good. Hopefully I will get all new ones. But I also have severe trismus. Can't remember if you have that also. Losing weight was at 148 now at 136 hard to eat with no teeth. Hope you are having a great day!❤️🙏
Just lower teeth as I only had the lower jawbone or mandible replaced.
I already did, they said can't stitch up right now to soon after surgery, will look at it when I go back at the end of April. They said it looks good and tissue is healthy. Probably waiting for more swelling to go down is my guess
-
Like -
Helpful -
Hug
1 ReactionMy experience was the post bases were installed at time of bone replacement. After everything healed, then the post bases had to be revealed with a minor surgery and pegs were installed, which protruded above the gum line. This then had to heal up around the pegs for about two months before a temporary prosthesis was installed, which also was replaced with a permanent one two months later.
The most annoying part was having the pegs sticking out and trying to chew. I ate a lot of soft foods that summer.
-
Like -
Helpful -
Hug
1 ReactionThat doesn't sound fun. I wonder what I will have to go through. Nervous and the expenses on traveling. It's hard coming up with money. Sounds like I will be traveling There alot at first.
Hey it's Darcy again with more questions. Is it normal to feel no energy and tired all the time into 2 1/2 months after surgery? I'm not a person that likes to sit around, I can't even clean the whole house without being exhausted. Any feedback will help. Thanks ❤️
-
Like -
Helpful -
Hug
1 ReactionHi Darcy
With severe trismus you can feel tired and disheartened which can drain your energy. I found myself with low energy recently and it turned out to be a spike in my thyroid (hyperthyroidism) which happens to many of us with head and neck. Ask them to check 🤷🏾♀️
Hope you get a boost soon
-
Like -
Helpful -
Hug
2 ReactionsThanks for your help. I will ask when I travel back there at the end of the month.
-
Like -
Helpful -
Hug
1 ReactionI had the Mandible Reconstruction with Fibula Free Flap surgery done last year in 2023. It was a rough time, the first interior flap failed due to an infection and they did another skin graft from my radial fore arm. Not to go into a lot of detail but surgeon cleared me early this year to proceed with prosthetic teeth, I have only one original tooth in my lower jaw. Oral surgeon had to thin the tissue to make way for the implants and in doing so exposed the bone and some of the hardware which is not healing. I was then advised that one of the fibular segments did not heal, so their is no blood supply which is causing the tissue not to grow back over and cover. I was informed today that I would have to go through the procedure again from the original surgeon that performed the first procedure. A little more history had oral cancer 8 years ago with chemo and radiation which developed into Osteoradionecrosis. I am currently cancer free. I have been on a liquid diet since March 2023. I am looking for the top 5 surgeons or surgical teams in the country that do this type of procedure for a second opinion.
hi @ld1262 Welcome to the Head and Neck group. Ouch! Third time? I would definitely find a different health center with experience. If the surgeons haven't done at least fifty of these, run away. And yes you are allowed to ask and you should. This is your mandible, not theirs. The micro surgery involved in the reconstruction is the most critical part and must be done by a steady, knowledgable surgeon.
I had fibula free flap used for mandible reconstruction in 2020, also due to osteoradionecrosis from cancer treatment like you. Successful. Had some infection due to excess flap material growing around the prosthetic teeth which had to be dealt with, twice. Aside from that, I'm doing great. Surgery done at Mayo, Rochester by the folks who pretty much perfected this and train others worldwide.
You might want to consider not having pegs for teeth and just get the jaw repair done. Seek out the best is all I can tell you. If you have further questions, there are several of us here who have had this rare procedure. So feel free to reach out and ask.
-
Like -
Helpful -
Hug
1 Reaction