Vascularized Fibular Flap for Reconstruction of the Condyle After Mandibular Ablation

• Published in: Journal of oral and maxillofacial surgery Vol. 66; no. 6; pp. 1133 - 1137
• Main Authors: González-García, Raúl, MD, Naval-Gías, Luis, MD, DMD, PhD, Rodríguez-Campo, Francisco J., MD, Martínez-Chacón, José L., MD, Gil-Díez Usandizaga, José L., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2008; Elsevier
• Subjects: Adult; Ankylosis - etiology; Arthroplasty - adverse effects; Arthroplasty - methods; Biological and medical sciences; Female; Fibrous Dysplasia of Bone - surgery; Fibula - transplantation; Follow-Up Studies; Humans; Male; Mandible - surgery; Mandibular Condyle - surgery; Mandibular Diseases - surgery; Mandibular Neoplasms - surgery; Medical sciences; Middle Aged; Oral Surgical Procedures - adverse effects; Oral Surgical Procedures - methods; Osteoradionecrosis - surgery; Otorhinolaryngology. Stomatology; Surgery; Surgical Flaps - blood supply; Temporomandibular Joint - physiology; Temporomandibular Joint Disorders - etiology; Temporomandibular Joint Disorders - physiopathology; Mandible; Fibula; Treatment; Stomatology; Surgery; Condyle; Anatomical reconstruction; Flap (surgery); Ablation
• ISSN: 0278-2391; 1531-5053
• DOI: 10.1016/j.joms.2007.06.680

Purpose The purpose of this study was to evaluate the outcome of the vascularized fibular free flap for the reconstruction of mandibular resections involving the condylar segment. Patients and Methods Six patients underwent mandibular resection including the condyle. Two patients were diagnosed with squamous cell carcinoma, whereas the other 4 presented fibrous dysplasia, mandibular osteoradionecrosis, mandibular ameloblastoma, and giant cell granuloma of the mandible. All of them underwent condylar reconstruction by means of transplant of the free fibular flap. In all the cases, the fibula was placed directly into the glenoid fossa. The temporomandibular disc was preserved over the pole of the fibula. Panoramic radiographs were performed postoperatively to evaluate condylar position and grade of bone resorption. Results Five patients developed adequate temporofibular function with absence of hypomobility and optimum interincisal opening, whereas 1 patient developed a temporofibular ankylosis with severe limitation of mandibular mobility and mouth opening. Conclusions The use of the fibula flap directly fitted into the glenoid fossa constitutes a reliable method in condylar reconstruction. However, the possibility of severe complications such as ankylosis has to be considered.