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Scientific Oral Presentations

Facial Plastic and Reconstructive Surgery

Session: Scientific Oral Presentations 3 - Facial Plastic and Reconstructive Surgery

Iliac Crest Bone Grafting With Fascia Lata Free Flap for Mandibular Osteoradionecrosis

Tuesday, October 1, 2024
11:30 AM – 11:36 AM EDT
Location: MBCC, 222
Disclosure(s):
Derek J. Vos, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Peter J. Ciolek, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Brandon L. Prendes, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Patients unresponsive to conservative management of osteoradionecrosis (ORN) of the mandible often require segmental mandibulectomy with reconstruction using free vascularized bone. At our institution, we routinely perform anterolateral thigh fascia lata (ALTFL) free flap to arrest or reverse ORN of the mandible. We have since combined this technique with iliac crest bone grafting (ICBG), to restore mandibular strength and height after debridement and report our experiences with this technique.

Methods: Retrospective chart review of patients who underwent ALTFL rescue flap with ICBG for mandibular ORN between 2011-2023.

Results: A total of 26 patients (mean age 66.6 years, 76.9% male) with ORN of the mandible underwent ICBG at the time of ALTFL rescue flap. Prior antibiotic usage and prior HBO therapy were reported in 76.9% and 38.5% of patients, respectively.

Mandibular subsites most commonly involved included the body (92.3%) and angle (57.7%). The majority of patients had over 1 cm of vertical mandibular height remaining following debridement (our primary indication for supplementary bone grafting).

Following ALTFL rescue flap with ICBG, the median length of stay was 3 days. There were two episodes of flap failure noted at follow-up, requiring additional ALTFL procedures. No other postoperative complications were noted. ICBG take was excellent in all patients, with no patients undergoing repeat grafting or osteocutaneous free flap. In patients with available postoperative Panorex imaging, mandibular height was restored to an average of 1.9 cm. A small subset of patients (n = 4, 15.4%), reported persistent ORN symptoms following this procedure and required additional debridement of mandible with antibiotic therapy. Including those patients requiring revision, no individuals demonstrated long–term clinical or radiographic progression of ORN.

Conclusions: In patients undergoing ALTFL rescue flap for arrest of mandibular ORN, ICBG appears to supplement mandibular height and strength, with arrest of clinical and radiographic progression of disease, and low morbidity and abbreviated hospital stays.

    Presenting Author(s)

  • Derek J. Vos, BS

    Medical Student
    Case Western Reserve University
    Cleveland, Ohio, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • KA

    Khashayar Arianpour, MD

    Cleveland Clinic Foundation, United States

    Disclosure information not submitted.

  • SL

    Sara Liu, MD

    Cleveland Clinic Foundation, United States

    Disclosure information not submitted.

  • Peter J. Ciolek, MD

    Assistant Professor - Facial Plastic and Reconstructive Surgery
    Cleveland Clinic Head and Neck Institute
    Cleveland , OH, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • BP

    Brandon L. Prendes, MD

    Brandon Prendes
    Cleveland Clinic Head and Neck Institute
    Cleveland, OH, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Senior Author(s)

  • MF

    Michael A. Fritz, MD

    Associate Professor CCLCM
    Cleveland Clinic Foundation
    Cleveland, Ohio, United States

    Disclosure information not submitted.