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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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I'm very scared. It can't be worse than what I have gone through in the last 5 years. Who was your doctor? I saw Dr. Arce when I was there and a few more just don't remember all their names. Are you glad you went through with it? Do you live in that area? What kind of insurance did you have. My sister and niece and great niece are CNA's hopefully that will be helpful. I just hope I'm doing the best thing for me. It's been a struggle the last 5 years. Sorry with all the questions. Hope you are doing well.
Hi Darcy. Yes I had a trach. The bugger was supposed to heal up on its own but never did. Required a follow up minor surgery to close which was done when I had my teeth prosthetic pegs opened up.
Scared? That just means you have good common sense. My first words written on the chalk board to my wife “ what have I done?”
That reminds me, make sure you have a good support person for the few weeks of home care, especially the first few days.
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2 ReactionsDid you have to have a trach.
That sounds wonderful corn on the cob. They already did all the images picture taking cts on head and legs. I can't wait. Scared but hopeful 🥰
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1 ReactionHi Darcy. For the surgical team to set up for resection surgery it will take them several weeks.
They will take various photos of your head which helps with the rebuilding. A CT scan is incorporated into a computer aided design (CAD) program so a 3-D printer can build a jig or fixture used to make the correct size and shape bone replacement section. All of this takes time behind the scene along with surgical coordination meetings and hospital schedules.
The number of people involved including during the surgery will astound you.
For me the it was about four months from initial consult and photos until surgery including a month while I thought about it and adjusted my schedule as well before giving the go-ahead.
Ten months after surgery I was eating corn on the cob, butter dripping down my chin, smile on my face. It was the first time in almost fifteen years being able to do that.
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2 ReactionsWhich Mayo Clinic are you all talking about?
I had scc stage 4 of the sinus cavity. 2018. It's been a rough road. I have trismus due to radiation. I have been wearing a obturator since surgery. It broke about 4 years ago and no one would fix it cause I couldn't open my mouth. Mayo was the best. I had 2 days of appointments and they fixed it while I was there. The best decision I made by going there. It's better than the first one. I'm excited and scared but I know in the long run I will be happy and be able to enjoy life again.
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1 ReactionThanks for sharing. I will be traveling to mayo to have the same thing done. I was happy to find this reading so I could understand things better. How long does it take before they get you set up. They said they have to figure out insurance.
Hello @brschultz33 When should you have the surgery? Since the question isn't "if you should" rather "when", then it is clear this needs to happen. The short answer is when it fits your schedule and that of the surgical team. I know it is a hard decision to make, going under the knife, being in hospital for a week, not getting around well for a month, etc. Not sure if you are scheduling around work or retired. I returned to work limited rather quickly but that's me, perhaps not you.
The ability to talk well or function without facial issues such as drooling within weeks after surgery may also limit your functionality with work or living in general. These things are usually temporary.
I think the biggest obstacle is having the courage to get this done. In that you are not alone. But I can pretty much guarantee that within a year after you will wonder why you didn't do this sooner. Good luck and I am here for you.
@brschultz33, I add my welcome. I moved your question about mandible reconstruction timing to this existing discussion in the Head & Neck Cancer support group.
- Mandible Reconstruction with Fibula Free Flap. Is this an option? https://connect.mayoclinic.org/discussion/mandible-reconstruction-with-fibula-free-flap-is-this-an-option/
I did this so you can read the previous helpful posts and connect easily with members like @hrhwilliam @kjwilson23 @sepdvm @city and others.
@brschultz33, what surgery have you had and when is mandible reconstruction being suggested for you?