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Reconstructing The Reconstructed: A 30-year Analysis Of Repeat Mandibular Osteoradionecrosis Management
Rami Elmorsi, MD, Z-Hye Lee, MD, Hrishabh R. Bhosale, BA, Lucia Martinez-Sanchez, BS, Austin Ha, MD, Patrick B. Garvey, MD, Edward I. Chang, MD, Rene D. Largo, MD, Matthew M. Hanasono, MD, Peirong Yu, MD,MS.
MD Anderson Cancer Centre, Houston, TX, USA.
Introduction: The reconstructive approach and outcomes for patients with Osteoradionecrosis (ORN) of the mandible who have already undergone prior mandibular reconstruction remain undescribed in the literature.
Methods: This is a 30-year retrospective analysis of mandibular ORNs on top of a prior same-side mandibular reconstruction, from 1994 to 2023.
Results: We identified 65 patients with mandibular ORN needing repeat reconstruction. Compared to first-time reconstructions, these patients had more complex defects, more revision surgeries, and worse speech outcomes (Table 1). Initial reconstruction type(s) did not affect final reconstruction outcomes (Table 2). In patients undergoing second bone flap reconstructions, outcomes were similar to first-time reconstructions, except for worse speech (Table 3).
Conclusions: Second-time mandibular defects due to ORN are more complex but can still be reconstructed using the same approach as the first reconstruction. However, patients should be informed beforehand that speech outcomes are likely inferior to first-time reconstruction.
First-time versus repeat mandibular reconstruction | No prior recon, N (%) = 292 (82) | Prior recon, N (%) = 65 (18) | p |
| Concomitant skin defect | 168 (58) | 53 (82) | <0.001 |
| Intact Condyle | 215 (74) | 46 (71) | 0.64 |
| Surgical site occurrences | 54 (18) | 12 (18) | >0.99 |
| Microsurgical complications | 19 (6.5) | 3 (4.6) | 0.78 |
| Partial flap loss | 11 (3.8) | 1 (1.5) | 0.78 |
| Total flap loss | 7 (2.4) | 1 (1.5) | 0.7 |
| Number of revisions = 0 | 150 (51) | 23 (35) | 0.036 |
| Tube-dependent feeds | 81 (28) | 25 (39) | 0.078 |
| ≤50% Intelligible speech | 18 (6.5) | 9 (15) | 0.038 |
Outcomes of repeat reconstructions grouped by type of first-time reconstruction | Soft tissue, N (%) = 31 (48) | Bone, N (%) = 28 (43) | Plate, N (%) = 6 (9.2) | p |
| New flap = soft tissue | 3 (9.7) | 9 (32) | 1 (17) | 0.083 |
| Donor site complications | 1 (3.2) | 1 (3.6) | 0 (0) | >0.99 |
| Recipient site complications | 5 (16) | 7 (25) | 0 (0) | 0.41 |
| Microsurgical complications | 1 (3.2) | 2 (7.1) | 0 (0) | 0.7 |
| Partial flap loss | 0 (0) | 1 (3.6) | 0 (0) | 0.7 |
| Total flap loss | 1 (3.2) | 0 (0) | 0 (0) | 0.52 |
| Number of revisions = 0 | 14 (45) | 7 (25) | 2 (33) | 0.18 |
| Tube-dependent feeds | 14 (45) | 11 (41) | 0 (0) | 0.12 |
| ≤50% Intelligible speech | 2 (7.4) | 7 (26) | 0 (0) | 0.13 |
Outcomes of free bone flaps in 2nd time reconstructions | First-time bone flap, N (%) = 211 (86) | Second-time bone flap, N (%) = 34 (14) | p |
| Donor site complications | 7 (3.3) | 1 (2.9) | >0.99 |
| Recipient site complications | 36 (17) | 9 (26) | 0.19 |
| Microsurgical complications | 15 (7.1) | 2 (5.9) | >0.99 |
| Partial flap loss | 10 (4.7) | 1 (2.9) | >0.99 |
| Total flap loss | 5 (2.4) | 0 (0) | >0.99 |
| Tube-dependent feeds | 57 (27) | 12 (35) | 0.34 |
| ≤50% Intelligible speech | 11 (5.4) | 10 (29) | <0.001 |
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