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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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Thanks for sharing. I will be traveling to mayo to have the same thing done. I was happy to find this reading so I could understand things better. How long does it take before they get you set up. They said they have to figure out insurance.
I had scc stage 4 of the sinus cavity. 2018. It's been a rough road. I have trismus due to radiation. I have been wearing a obturator since surgery. It broke about 4 years ago and no one would fix it cause I couldn't open my mouth. Mayo was the best. I had 2 days of appointments and they fixed it while I was there. The best decision I made by going there. It's better than the first one. I'm excited and scared but I know in the long run I will be happy and be able to enjoy life again.
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1 ReactionWhich Mayo Clinic are you all talking about?
Hi Darcy. For the surgical team to set up for resection surgery it will take them several weeks.
They will take various photos of your head which helps with the rebuilding. A CT scan is incorporated into a computer aided design (CAD) program so a 3-D printer can build a jig or fixture used to make the correct size and shape bone replacement section. All of this takes time behind the scene along with surgical coordination meetings and hospital schedules.
The number of people involved including during the surgery will astound you.
For me the it was about four months from initial consult and photos until surgery including a month while I thought about it and adjusted my schedule as well before giving the go-ahead.
Ten months after surgery I was eating corn on the cob, butter dripping down my chin, smile on my face. It was the first time in almost fifteen years being able to do that.
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2 ReactionsThat sounds wonderful corn on the cob. They already did all the images picture taking cts on head and legs. I can't wait. Scared but hopeful 🥰
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1 ReactionDid you have to have a trach.
Hi Darcy. Yes I had a trach. The bugger was supposed to heal up on its own but never did. Required a follow up minor surgery to close which was done when I had my teeth prosthetic pegs opened up.
Scared? That just means you have good common sense. My first words written on the chalk board to my wife “ what have I done?”
That reminds me, make sure you have a good support person for the few weeks of home care, especially the first few days.
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2 ReactionsI'm very scared. It can't be worse than what I have gone through in the last 5 years. Who was your doctor? I saw Dr. Arce when I was there and a few more just don't remember all their names. Are you glad you went through with it? Do you live in that area? What kind of insurance did you have. My sister and niece and great niece are CNA's hopefully that will be helpful. I just hope I'm doing the best thing for me. It's been a struggle the last 5 years. Sorry with all the questions. Hope you are doing well.
I also had Dr. Arce and Dr. Kyle Ettinger, who was my primary contact. It took me about a month to think about doing it but yes, very glad I had this done.
I live in Illinois about four hours away so return visits were not really a problem.
I was sent home with a CAM boot on my leg, a feeding tube out my nose, and all the gear for tube feeding which my wife took charge of including crushing medication and diluting with water for the tube. I am now three years out and really have no issues. I work around horses three days a week so I am on my feet.
I suffered with issues for years as I traveled the world for work as an engineer. Constant infections and pain, had to watch what I ate, etc.
I had at the time standard business group insurance and transitioned to standard Medicare without issues.
I think you are in very good hands both with your doctors and with your support staff. I know it can be scary but sometimes we just have to face the world and hope for the best.
Have your support people message me if they want/need to if they have questions. You actually will not need all that much help, mostly just feeding and getting some exercise/physical therapy if you want to live well after recovery. My wife had me walk around the car at a truck stop on I90 in the freezing cold on the way home just so I didn't have any issues. I'm sure the truckers were amused.
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4 ReactionsJust wanted to let you know my surgery is scheduled for November 14th. Alot faster than I thought. Now have to figure out if there is any help available for people that need help with medical needs flying to there and back. Thanks for all your input and help. Much appreciated 🥰🙏❤️
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