Mandible Reconstruction with Fibula Free Flap. Is this an option?

Posted by William Olsen, Volunteer Mentor @hrhwilliam, Aug 6, 2023

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.

William Olsen, Volunteer Mentor | @hrhwilliam | Oct 14, 2023

In reply to @darcybechtel67 "Columbia Falls Montana. Our airport is glacier national" + (show)

Darcie,
You can call the Patient Travel Services at Rochester 866-551-3392 and be ready with your patient account number. Also check out the web page Mayoclinic.org and tab on Care at Mayo Clinic, then Patient Visitor Guide. Fill out the request form. No guarantees.
I see where you are located. Small aircraft usually won't do mountain flying in the winter which leaves us with jet service only. Angelflightswest for your district doesn't go east past Montana. There are other organizations out there other than Angel Flights. We have one here in the Midwest which I participate with.

darcybechtel67 | @darcybechtel67 | Oct 14, 2023

In reply to @hrhwilliam "Darcie, where are you located?" + (show)

Columbia Falls Montana. Our airport is glacier national

William Olsen, Volunteer Mentor | @hrhwilliam | Oct 14, 2023

In reply to @darcybechtel67 "Thyi did try Angel flight. But they said they only travel to mayo in Arizona or..." + (show)

Darcie, where are you located?

darcybechtel67 | @darcybechtel67 | Oct 13, 2023

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.

William Olsen, Volunteer Mentor | @hrhwilliam | Oct 13, 2023

In reply to @darcybechtel67 "Ok thanks. I only have a few teeth left on good side on top of mouth...." + (show)

You could try angelflight.com and there are others as well. Some airlines (southwest) have medical discounts. Rochester has an airport with shuttles so many folks don't bother with a rental car. Minneapolis MSP airport is another option being only about an hour drive away where often the flights are cheaper than directly into RST. Delta is the main airline in both locations.
I certainly do not miss the weeks/months/years of antibiotics and tooth pain. I wish you well.

darcybechtel67 | @darcybechtel67 | Oct 13, 2023

In reply to @hrhwilliam "Lower left side only. Pegs were installed in the bone graft when the resection was performed...." + (show)

Ok thanks. I only have a few teeth left on good side on top of mouth. They are broken though. Bottom 4 teeth pulled next week cuz I have lots of pain been on antibiotics 3 times. So I will only have a few then. I'm hoping they can fix all of them so I can eat meat and food again. Do you know of any medical flight that travel there. The one I called said they only go to Arizona and the west coast. Hope you have a great day.

William Olsen, Volunteer Mentor | @hrhwilliam | Oct 13, 2023

In reply to @darcybechtel67 "Another question ❓ Did you get both upper and lower teeth? Did they do them when..." + (show)

Lower left side only. Pegs were installed in the bone graft when the resection was performed. If I elected at that time not to have pegs installed, having a permanent prosthetic later on would not be an option.

darcybechtel67 | @darcybechtel67 | Oct 12, 2023

Another question ❓ Did you get both upper and lower teeth? Did they do them when you got your first surgery? Thanks

darcybechtel67 | @darcybechtel67 | Oct 11, 2023

In reply to @hrhwilliam "I also had Dr. Arce and Dr. Kyle Ettinger, who was my primary contact. It took..." + (show)

Just 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 🥰🙏❤️

William Olsen, Volunteer Mentor | @hrhwilliam | Oct 10, 2023

In reply to @darcybechtel67 "I'm very scared. It can't be worse than what I have gone through in the last..." + (show)

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.