Hi everyone,

My dad went through surgery this past Friday, including removing a portion of his jawbone on one side. The plastic surgeon had told us that they would be using a fibular flap to reconstruct it. However, after the surgery, we were told that the portion of the bone that had to be removed in order to get good margins was too large for the fibular flap, as it essentially involved the entire bone up to the TMJ joint on one side.

Because of this, the ENT resident said that they instead used a flap composed entirely of muscle tissue, as opposed to any bone. He said that this will not be noticeable unless someone is actually touching his jaw.

I've done some basic reading and haven't been able to find any reference to a boneless, muscle-based mandible reconstruction. Does anyone else have any experience with this, either in terms of why this option would have been chosen or what my dad can expect when he recovers. Also, can anyone point me to any other resources that discuss this sort of reconstruction more in depth? Thanks.

This is not a very common procedure. Most patients with a mandibulectomy have their jaw replaced with the fibular or hip bone, some even use cadaver bones. I had my mandibule originally replaced with a metal jaw. The free flap failed, the mental jaw was removed and the free flap was redone. Im now 15 months post surgeries and have had my first reconstruction surgery. I might be about as close as you can get to anyone having a similar procedure as your father. I can tell you that is a very long road to recovering from this type of surgery. It takes a good 6 months before the swelling subsides and he feels somewhat back to normal. Please feel free to ask any other questions you may have, I will be happy to help you.

I realize that it is quite uncommon, as I haven't been able to find any reference to anything exactly similar. Unfortunately, we haven't been able to sit down to discuss things with the plastic surgeon himself yet.

After a bit more research, I was able to find at least a few references to this sort of reconstruction. I figured I`d post it here for anyone who was interested. The NIH has an abstract of a study on their site that discusses this issue at: http://www.ncbi.nlm.nih.gov/pubmed/20134360.

Basically, it looks like this is used in cases where the mandibular defect is posterior, close to the TMJ. Apparently the results are very close to bone flap reconstructions.

I`m feeling a bit better after reading that, given how confused I was as to why this would have been done in my dad�s case, or what the results might be. At least I know it�s not an unprecedented thing!

I should have posted to this thread earlier as I have a background in implantable devices. But reconstructions that involve metal components, while we think of them commonplace in hips, knees, and the like, are also quite old ideas and common in head injuries and mandibular reconstructions. If you take a look at one of the menu pages that we are building on the OCG site,

http://oralcancerfoundation.org/restoration/index.htm

you can see one of the early designs in use in a very retouched radiograph. Notice that an entire section of the mandible is missing. The design in this image has been greatly improved on in the last five years. The stability of a metal implant based reconstruction is significant, but as posted above there can be issues with survivability in radiated bone. So there are ( as always ) trade offs.

My understanding of what was done with my dad, though, was not that anythign was implanted, but that he was simply given a soft tissue free flap.

This is what Roger Ebert has and others here. The drawbacks to it is that what it improves esthetics significantly, it has no stability to allow for restoration of function. In some patients, that have dysphagia to the extreme, function isn't an issue anymore so this is more than adequate. Those people like Ebert, are not going to be chewing foods, usually have multiple issues related to other anatomical shortcomings that would also compromise full rehabilitation, and the goal is to have them stable and in an esthetic state that allows them some sense of feeling good about their appearance, particularly in public. Not every patient after all this can be restored to full function, so there are a variety of modalities in approaching this all highly individualized to a particular patients situation.