Mohamed Tarek Hafez1*, Khaled Abdel Wahab1, Sameh Roshdy1, Fayez Shahatto1, Waleed el Nahas1, Mohamed El Metwally1, Fathy Denewer2, Omar Farouk1 and Adel Denewer1
1Surgical oncology unit, Mansoura oncology center, Mansoura University, Egypt
2General surgery, Mansoura insurance hospital, Egypt
Received: 06 June, 2016; Accepted: 25 June, 2016; Published: 28 June, 2016
Mohamed Tarek Hafez, Lecturer of surgical oncology. Surgical oncology unit, Mansoura oncology center, Mansoura University, Egypt, Tel: 00201211700004; E-mail:
Hafez MT, Wahab KA, Roshdy S, Shahatto F, el Nahas W, et al. (2016) Versatility in Mandibular Reconstruction after Ablative Tumor Surgery, Single Center Experience. Arch Otolaryngol Rhinol 2(1): 030-034. DOI: 10.17352/2455-1759.000019
© 2015 Hafez MT, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Mandibular reconstruction; Microvascular; Free flap
Mandibular reconstruction using vascularized osteocutaneous flaps is necessary to improve functional outcomes, such as jaw movement and mastication, and aesthetics after the wide resection of the mandible .
Bone grafts had been widely used for reconstruction, with the advent of microsurgery, such as rib , metatarsal , radial , scapular , iliac , and fibular [7,8].
Using the fibula for reconstruction of mandibular defects through microvascular technique was first described by Hidalgo in 1989 . This microvascular flap depends on peroneal artery and the accompanying veins. This flap is characterized by rich vascularity with a long and wide pedicle as the vascular nourishment to this bone comes through both segmental and intraosseous ways, so, it can withstand multiple osteotomies without fear from any ischemic complications . This makes reconstruction of large defects after radical tumor resection more easy.
Thirty years ago, iliac crest was the first choice for surgeons in reconstruction of the mandible after tumor resections. The resemblance of the iliac crest to the contour of the mandible made it suitable for such reconstruction . In the earlier series, the superficial circumflex iliac vessels were utilized in the free microvascular anastomosis for the conjoined skin flap with iliac bone.Later, Taylor et al. proved the advantage of utilizing the deep circumflex system .
Sternocleidomastoid clavicular flap was first reported by colney for reconstruction of mandibular defects in 1972, using the medial fragment of the clavicle . Later, some reconstructive surgeons talked about some modifications of this technique to improve the outcome of this free microvascular flap .
Nowadays, reconstruction after mandibular tumor resections requires high level of complexity that not only puts into consideration the type of the bone flap to acquire accepted cosmetic and functional outcome, but also, decreasing the donor-site morbidity and the probability of using prosthesis, promoting higher quality of life .
The aim of this study is to assess the feasibility and versatility of mandibular reconstruction using three different vascularized osteocutaneous flaps; fibular free flap, iliac crest free flap and pedicled sternocleidomastoid clavicular flap.
Patients and Methods
This is a retrospective study studying patients admitted to our surgical oncology department in Mansoura oncology center, Mansoura University diagnosed with mandibular tumors or intraoral tumors infiltrating the mandible between June 2011 & February 2016. Ethics approval was obtained from the Ethics Committee board of the Faculty of Medicine, Mansoura University.
Forty patients were enrolled in this study. Sixteen patients were males and 24 were females, their ages ranged from 19 – 63 years. All tumors were primary except seven cases were recurrent after successful surgical resection. The pathologic diagnosis was ameloblastoma in 24 patients, intra oral carcinomas infiltrating the mandible 12 patients and skin Sq.C.C infiltrating the mandible in 4 patients. All Patient Characteristics are shown in Table 1. 18 patients had Fibular Free Flaps (Figure 1), 10 patients had Iliac Crest Free Flaps (Figure 2) and 12 patients had Pedicled Sternocleidomastoid Myo-osseous (Clavicular) Flap (Figures 3,4).