RECONSTRUCTION OF POSTERIOR MANDIBULAR DEFECTS WITH SOFT-TISSUE USINGTHE RECTUS-ABDOMINIS FREE-FLAP

Immediate reconstruction of posterior mandibular composite defects by replacement with vascularised bone is ideal in principle, but may have excessive morbidity for certain patients who, because of poor general health or a poor tumour prognosis, are not good candidates for a comp lex surgical procedure. Also, if the temporomandibular joint (TMJ) is missing, the continuity of the entire mandible cannot be restored with out either reconstructing the TMJ or resorting to a prosthesis. For su ch patients, reconstruction of the posterior defect without bone using a rectus abdominis free flap or other soft-tissue flap may be a good alternative. A series of 21 patients with posterior mandibular defects underwent this type of reconstruction. The patients reconstructed onl y with soft tissue were found to have a reasonable cosmetic appearance , and speech and swallowing function were very acceptable. For posteri or mandibular defects that include a missing condyle this approach is an acceptable alternative, especially for patients who are poor candid ates for more complex surgical procedures.