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?

Interested in more discussions like this? Go to the Head & Neck Cancer Support Group.

In reply to @darcybechtel67 "Big hole" + (show)
@darcybechtel67

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.

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@darcybechtel67

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

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Big hole

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@hrhwilliam

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!

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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

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@darcybechtel67

It 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

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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!

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@hrhwilliam

Just 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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It 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

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@darcybechtel67

My surgery date has changed, will know the week of the 6th.

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Just 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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@hrhwilliam

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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My surgery date has changed, will know the week of the 6th.

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@colleenyoung

@darcybechtel67, I agree with @hrhwilliam to call Mayo Patient Travel Services at Rochester. You may also wish to talk to someone at Mayo Clinic's Concierge Services to discuss options.

Concierge services are complementary and available in person or by phone, live chat, email or online form.

Here is information for Contacting the Concierge Services:
– In person: Concierge Services desk
Mayo Building (lobby level, in the International Center)
Monday-Friday: 8 a.m. to 5 p.m.
No appointment necessary
By phone 7 a.m. to 6 p.m., Monday-Friday: 507-538-8438
Email: concierge@mayo.edu
Online: Request Concierge Services (if you go to the link below, you can link directly to this )

Concierge services
https://www.mayoclinic.org/patient-visitor-guide/minnesota/concierge-services

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Thanks

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@darcybechtel67

Thyi did try Angel flight. But they said they only travel to mayo in Arizona or the west coast. I need to go to Rochester. I can't wait till I don't have to deal with pain pills etc anymore. I can't wait for the outcome.

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@darcybechtel67, I agree with @hrhwilliam to call Mayo Patient Travel Services at Rochester. You may also wish to talk to someone at Mayo Clinic's Concierge Services to discuss options.

Concierge services are complementary and available in person or by phone, live chat, email or online form.

Here is information for Contacting the Concierge Services:
– In person: Concierge Services desk
Mayo Building (lobby level, in the International Center)
Monday-Friday: 8 a.m. to 5 p.m.
No appointment necessary
By phone 7 a.m. to 6 p.m., Monday-Friday: 507-538-8438
Email: concierge@mayo.edu
Online: Request Concierge Services (if you go to the link below, you can link directly to this )

Concierge services
https://www.mayoclinic.org/patient-visitor-guide/minnesota/concierge-services

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