Outcomes of Osseous Microvascular Free Flap Reconstruction for Mandibular Osteoradionecrosis: A Systematic Review and Meta-analysis

Monday, September 30, 2024

4:12 PM – 4:18 PM EDT

Location: MBCC, 208

Disclosure(s):

James R. Gardner, MD:

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

Soroush Farsi:

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

Anna C. Benafield:

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

Hayden Carl Hairston, MD:

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

Introduction: Mandibular osteoradionecrosis, a severe outcome of head and neck cancer radiotherapy, typically emerges months to years after treatment. In cases where conventional medical interventions prove ineffective, surgical options, such as microvascular reconstruction with various free flap types, become necessary. This study aims to evaluate the success rates and complications of different flap types, providing insights for clinical decisions in managing patients with mandibular osteoradionecrosis.

Methods: Embase, PubMed, Cochrane, and Web of Science were comprehensively searched for articles up to 2023, following PRISMA guidelines. This review is registered with PROSPERO (CRD42023456929). A meta-analysis, using the inverse variance method and a fixed effects model with OpenMeta software was conducted. The included studies' quality was assessed with MINORS Criteria.

Results: From 718 abstracts, 19 full-text articles (397 patients) were reviewed. Patients, averaging 55.7 years old, showed signs of osteoradionecrosis (ORN) around four years post-radiation (mean dose: 5057 cGy). Squamous cell carcinoma was predominant (67%). Flap types included fibula (63%), iliac crest (36%), scapula (3.7%), and radial forearm (3.5%).Meta-analysis of the studies revealed a pooled postoperative complication rate of 22.5% (95% CI 0.165-0.284, I2:48%). Further subgroup analysis indicated that radial forearms had the lowest complication rate, with a pooled rate of 13.5% (95% CI 0.026-0.295, I2:0%), while scapula displayed the highest among the bony flaps at 34.9% (95% CI 0.039-0.66, I2:40.3%).In terms of flap loss/failure, the fibula exhibited the lowest rate at 3.2% (95% CI 0.003-0.025, I2:0%), whereas the radial forearm showed the highest rate at 13.4% (95% CI 0.026-0.295, I2:0%).

Conclusions: Our meta-analysis identifies the radial forearm has the lowest complication rate, while the fibula has the lowest flap loss. Limited evidence underscores the necessity for more robust, multi-institutional prospective studies to determine optimal donor tissue and factors predicting outcomes in free flap procedures.

Presenting Author(s)

James R. Gardner, MD

Resident Physician
University of Arkansas for Medical Sciences
Little Rock, AR, United States

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

Co-Author(s)

Soroush Farsi

Medical Student
Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences
El Paso, Texas, United States

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

Anna C. Benafield

Medical Student
UAMS
Little Rock, Arkansas, United States

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

Elizabeth Dorman

UAMS, United States

Disclosure information not submitted.
Hayden Carl Hairston, MD

Resident Physician
University of Arkansas for Medical Sciences (UAMS)
Little Rock, AR, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Mauricio A. Moreno, MD

Professor
University of Arkansas for Medical Sciences (UAMS)
Little Rock, AR, United States

Disclosure information not submitted.

Senior Author(s)

JS

Jumin Sunde, MD

University of Arkansas for Medical Sciences, USA

Disclosure information not submitted.