(0534) Transoral Minimal Acccess Approach for Reconstruction of Segmental Mandibulectomy With Fibula Free Flap

Introduction: Fibula free flap (FFF) for segmental reconstruction of mandibular osteoradionecrosis (ORN) is traditionally done via transcervical approach for ease of exposure and fixation. This requires extensive dissection through an irradiated and often previously operated surgical field, which incurs significant morbidity and risk of postoperative complications. To avoid this risk, we have combined a limited transoral approach for mandible reconstruction with minimal access vessel isolation and anastomoses, with the intent of decreased patient morbidity and improved postoperative outcomes.

Methods: Retrospective review of patients who have undergone FFF reconstruction of segmental mandibulectomy via transoral plating and inset at our institution from 2011 to 2023.

Results: Ten patients (mean age of 67.1, 100% male) with mandibular ORN underwent FFF reconstruction via transoral approach with minimal access vessels isolation. Majority of patients failed conservative management of ORN, with 80% of patients receiving prior antibiotic therapy and 70% undergoing hyperbaric oxygen therapy. All patients had advanced ORN which required segmental resection for clearance. Pre-operative fracture/non-union and fistula were noted in 6 and 4 patients, respectively. Mean size of bony defect reported intraoperatively was 5 cm.
Median length of hospitalization following this procedure was 6 days (range: 4-9). Complications were minimal, with no patients experiencing operating room takeback, readmission within 30 days, hematoma, fistulas, or flap compromise. Additionally, no patients required post-operative tracheotomy.

Conclusions: Mandibular reconstruction using a transoral approach with FFF offers an alternative to the more traditional open approach, with decreased patient morbidity and improved postoperative outcomes.