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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?
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Hi William Olsen and others,
I’m a retired family doc who had chemoradiation for SCC of my tongue base 19 years ago. About 9 months ago during a routine dental visit I was found to have osteradionecrosis of my left jaw. I had oral surgery to remove 2 teeth and clean out the necrotic bone. I had good soft tissue healing but 2 weeks ago on follow-up was found to have progression to a pathological mandibular fracture.
It’s been daunting and scary to contemplate getting bone graft and free flap reconstructive surgery.
The comments on this support group chat have really helped me with my attitude and anxiety about going forward. I’m still in the process of deciding where I will have the surgery.
Thanks again to all of you on this thread!
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3 ReactionsHi Doc,
I was 65 when I had my mandiblectomy surgery. I understand the reluctance as I worked it out in my head for about two months. I think what sold me on the surgery was the idea of not having the surgery, having a fracture of the mandible, which then becomes an emergency or worse. However, after going through cancer treatments years before, I realized the healing would be faster and likely far fewer side effects. While a bit more involved than a BHR hip surgery, I found the entire process agreeable. It also results in a great story when the scars are discovered. And to make a shameless plug, I had this done at Mayo Clinic Rochester by a surgery team that has trained others in this procedure worldwide. I went forth with little worry, resultant successful and quickly became an advocate for this surgery, complex as it is.
I wish you well sir. That future day when you bite into a fresh ear of corn without pain or worry, don't be surprised if tears of joy soon follow.
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1 ReactionMr Olsen,
Thanks again for your kind and encouraging words. I live in western Ohio and have one opinion from a local reconstructive surgeon whe does many of these; I’m also going to Cleveland Clinic, which is where I had my original cancer treatments. Dr Fritz has published extensively on jaw reconstruction so I expect he’ll have a wealth of experience and knowledge.
I’d consider Mayo but the travel from here would be longer than for you and my wife would be driving for the first several rechecks.
I’ll keep you posted as things progress.
Sweet corn is great in this area every summer so that’s a goal for sure!!
Mike
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2 ReactionsWhen I posted about my total tongue removal, I should have mentioned where this started. In 2019, I woke up to what I thought was a horrible toothache. After many visits to dentists and all kind of specialist and many X-rays, they said no cancer, but that tooth needs to come out. The surgeon they sent me too didn't like the way it looked, so he sent me to an oral facial cancer specialist. They removed a portion of my left mandible and replaced it with a bone from my right forearm. 2 years later, recurrence to my tongue. I am cancer free today. I have a wonderful husband who has been right there with me the whole time. He is not only my loving husband he became my nurse lol.
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1 Reaction@hrhwilliam Great description on your journey. My surgeon who I keep seeing after my 4/24 tongue cancer surgery, radiation and repeated infections, keeps mumbling something about reconstruction of the mandible. Now I have a clearer picture of what he mumbles about. Thank you.
@tri327dent It’s not by any means a simple surgery. It is also considered a rare surgery, which means many physicians are not even aware of it or have ever seen it in a patient. Specifically I advise patients to seek out a clinic, hospital, or cancer center that has had training and experience in performing this operation. The tricky part is the micro surgery to connect the blood supply as well as sparing as much in the nerve tissues as possible. Initially in the operating room I had counted I believe it was nineteen people including doctors, surgeons, nurses, techs, lab personnel, surgeons in training, and even a photographer. So as I said, not a simple surgery.
Make sure you go where the experienced practice and never hesitate to ask about that standard.
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1 Reaction@hrhwilliam
Your warning is heeded.
This sort of surgery is only mentioned to me by the surgeon who is doing my follow up. He is trying to find a possible reason for reoccurring infections after two years since radiation.
In the Canadian health system I have found it advantages to investigate these possibilities before I continue to speak with doctors so I don't get pushed into poor outcomes. Thanks again for your input.
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3 ReactionsI had this surgery on my upper jaw in the Twin Cities, Minnesota USA at North Memorial Hospital. It takes a long time for the bone graft to heal and make sure there is no recurrence of the cancer before having teeth replaced. As the swelling and lymphedema has subsided, friends and colleagues with medical backgrounds comment that my surgical team did an amazing job on my fibula flap replacement. I am realizing how fortunate I was to have this available close to home. Treatment at Mayo Clinic in Rochester was also an option but my Stage IV SCC diagnosis prompted me to seek care as soon as possible.
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2 Reactions@doctrygger I had anxiety over that possibility for many years. Fluoride compound prescription use in mouth guards are a preventative measure (per my cancer dentist…love that guy). Also hyperbaric chamber treatment before surgery and after surgery enhances the healing process significantly. Zero harm in taking anxiety medication…I did that for several years. Support groups of like people and Bible study are my reminders to not be afraid. 🙏💪
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