SURGICAL-MANAGEMENT OF THE OSTEORADIONECROTIC MANDIBLE WITH FREE VASCULARIZED COMPOSITE FLAPS

Osteoradionecrosis (ORN) of the mandible is a serious sequel to radiot herapy administered for malignant neoplasms of the head and neck. In a retrospective/prospective study, 28 patients with mandibular defects due to ORN were reviewed. Monocortical and bicortical defects as well as pathological fractures were reconstructed by means of a free serrat us anterior/rib (n = 8) or a vascularised iliac crest flap (n = 25). A ll the former survived; a pathological fracture, however, occurred pos toperatively in 2 of the patients (25%). Five iliac crests were lost ( 20%). The remaining bone struts healed well. The donor site morbidity was very low. Clinical and radiological longterm follow-up showed that a very acceptable functional and cosmetic result was achieved in all cases. Progress of ORN was prevented in ca. 90% of all patients. The r adiological follow-up was facilitated with the use of high-resolution CT-scans.