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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 your help. I will ask when I travel back there at the end of the month.
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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
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2 ReactionsHey 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 ❤️
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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.
My 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.
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1 ReactionI 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
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1 ReactionJust lower teeth as I only had the lower jawbone or mandible replaced.
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!❤️🙏
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.
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.