Microvascular reconstruction of segmental mandibular defects without tracheostomy.
OBJECTIVE
To report our experience with mandibular resection and reconstruction using vascularized bone-containing free flaps without an elective tracheostomy.


STUDY DESIGN
Case series with chart review.


SETTING
Tertiary referral hospital center.


SUBJECTS AND METHODS
Sixty-six patients undergoing mandibular reconstruction with vascularized bone-containing free flaps without an elective tracheostomy were identified between 1995 and 2013. We describe patient, tumor, and surgical factors and report perioperative outcomes in this population.


RESULTS
Most patients underwent fibula free flap reconstruction (n = 61, 92.44%). The 4 most frequent indications for resection were osteoradionecrosis, parotid carcinoma, oral squamous cell carcinoma, and osteomyelitis. Bone defects ranging from 4.0 to 13.0 cm were reconstructed, and associated soft-tissue defects were reconstructed with skin paddle sizes ranging from 24.0 to 450.0 cm(2). There was only 1 patient with a bilateral central mandibular defect, and there were no tongue/pharyngeal soft-tissue defects or bilateral neck dissections. One case required emergent tracheostomy on postoperative day 1, and 2 more patients developed respiratory complications. There were no cases of perioperative death or flap failure.


CONCLUSION
Mandibular free flap reconstruction is feasible without an elective tracheostomy in a subset of carefully selected patients without bilateral central mandibular defects, tongue/pharynx defects, or bilateral neck dissection.
['Moubayed|Sami P|SP|', 'Barker|Daniel A|DA|', 'Razfar|Ali|A|', 'Nabili|Vishad|V|', 'Blackwell|Keith E|KE|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D016025:Bone Transplantation D005260:Female D006801:Humans D008297:Male D008339:Mandibular Neoplasms D008866:Microsurgery D008875:Middle Aged D019651:Reconstructive Surgical Procedures D013524:Surgical Flaps D014139:Tracheostomy D016896:Treatment Outcome
tracheostomy free flap mandibular reconstruction complications