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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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Mr 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 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 ReactionHi 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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2 ReactionsMy husband is undergoing mandible free flap surgery on September 23 rd. In 2021 he had squamous cell carcinoma in his left cheek and had it removed with a flap as well as vein and artery from his wrist basically implanted into his cheek. His squamous cell is back in his mandible, as well as mandible disintegration due to radiation. He has already had all his f his teeth removed.
Anyone in the Rocky Mountain region that has issues should go to the Huntsman Cancer Institute in Salt Lake City the staff there has done these surgeries many times and are very kind and knowledgeable
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1 ReactionYes 7yrs out after removal of my tumor, tonsil and part of my tongue, place in my mouth is still raw,had all 11 teeth that were left pulled had a beautiful, perfectly fitting set of dentures made through government aid and can not even wear the bottoms because of this
I'll second exploring the MD Anderson option if you're in Texas, specifically the Head and Neck Center. While I'm having targeted chemotherapy, I did discuss the radical resection and fibular flap with Dr. Gillenwater. Very knowledgable. They will take a team approach.
https://www.mdanderson.org/patients-family/diagnosis-treatment/care-centers-clinics/head-neck-center.html
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1 ReactionStephen Y. Lai, M.D., Ph.D. at MD Anderson authored a paper titled "Radiomic Correlates of Mandibular Osteoradionecrosis after Radiation Treatment of Head and Neck Cancer Patients" You might want to start with him. https://faculty.mdanderson.org/profiles/stephen_lai.html
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2 ReactionsAny particular sugeon?
MD Anderson is a good option.
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3 ReactionsActually in Texas, but not opposed to travel. The only thing that concerns me are the follow-ups. Thanks for your input
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