Reconstruction of the marginal mandibulectomy defect: an update

Objective: The purpose of this study is to provide an update to the reconstructive management of the marginal mandibulectomy defect. Study design: Twenty-six consecutive patients were retrospectively reviewed. Methods: Patient and tumor variables were extracted from the medical record. Outcomes that were examined included method of reconstruction, frequency of osteoradionecrosis, and resumption of an oral diet. Results: Fifteen (57.7%), 8 (30.8%), and 3 (11.5%) patients were reconstructed with a skin graft, primary closure, or a radial forearm free flap, respectively. Indications for a radial forearm free flap were reconstruction of an associated subtotal glossectomy defect, a through-and-through check defect, and a maxillectomy defect. Five patients reconstructed with a skin graft also received postoperative radiation therapy. One (20%) developed osteoradionecrosis. Excluding patients with recurrent tumors (n = 5) or osteoradionecrosis (n = 1), all patients at last follow-up were maintaining an oral diet. Conclusions: Skin graft remains a preferred method of reconstruction for the marginal mandibular defect. A free flap is reserved for those marginal defects where additional soft tissue is needed to reconstruct subtotal glossectomy defects or defects of the midface and/or maxilla. Because of the potentially increased risk of osteoradionecrosis, reconstruction with a free flap instead of a skin graft should be considered if a patient will receive postoperative radiation therapy. (C) 2007 Published by Elsevier Inc.