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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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1 ReactionMy surgery date has changed, will know the week of the 6th.
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2 ReactionsJust checking in with you on your mandible surgery, how it went and how you are doing. I know it was a difficult travel situation for you especially this past winter. Hope all is well.
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1 ReactionIt was ruff, no lie. Been home since February 8th. Slowly recovering. Fly back April 29th, appointment on April 30th and May 1st to see how I'm healing and how strong my bones are to determine on what kind of teeth I will get. How many times did you have to go back
Several trips in the first year. Now once per year. Still have issues with the teeth prosthetic. Jaw is great. Learning how to play the bugle again even though part of my lower lip is numb.
We both are in a small club. Great scars and incredible story to tell. Your dentist will likely be the most interested as this is such a rare thing.
Glad to hear you are on the mend. In six months you should feel great. What an adventure!
I can't wait to get teeth so I can eat real food, I have a huge hole next to the side of nose where the stitches ripped open due to swelling. It sucks. Got some butterfly bandages but it's not pulling together very well. Hopefully they will fix it next go around
Big hole
Oh Darcy! So sorry to see and know what you are going through. Me, I looked like John Merrick also known as The Elephant Man for about six weeks.
It looks like you might need a stitch or two. Have you checked with Mayo to see if you should wait until your April appointment or perhaps have that done locally? You can just call the oral and maxillofacial desk and they will get back to you within the day usually. For me my trach did not close and had to be stitched up almost five months later, but I was in no rush. My wife was going to rent me out to kid's parties to blow up balloons from my neck lol.
I like the saying that scars make better stories than tattoos. When people at the beach ask me what happened to my leg I just say "Don't swim with sharks." That usually ends the nosey conversation.
It takes a couple of years for all of the pains to completely subside but in a month or two you should be about 80% recovered. Sending a hug from Illinois.
I had Dr's Arce and Ettinger at Mayo. Curious who you had.
Hi, I also have those doctors. I have been touching base with them. I should send them a picture of my nose. I was at first when I got home. They said it would get worse before it got better but that was the first of February or so. Thanks for thinking about me means a lot. I'll keep you updated. So did you get implants for teeth or false. They said next appointment is to see how I'm healing and how strong my bones are to determine what kind of teeth I get. I also meet with dental specialist and Dr. Arce.
Yes I had three posts installed to support a prosthetic set of four teeth in the lower position. Uppers were ok.
Send that picture to Dr Ettinger or Dr Arce and he will let you know what to do next.