The free vascularized flap and the flap plate options: Comparative resultsof reconstruction of lateral mandibular defects

Objectives/Hypothesis: Reconstruction of the mandible and oral cavity after segmental resection is a challenging surgical problem. Although osteocutan eous free flaps are generally accepted to be optimal for reconstruction of anterior defects, the need for bony reconstruction for a pure lateral mandi bular defect remains controversial. Study Design: A retrospective study. Me thods: A retrospective comparative study of short- and long-term outcomes o f three different reconstruction techniques for lateral defects was perform ed. In total, 57 patients were included, of whom 27 had a plate and pedicle d pectoralis major myocutaneous nap (PMMF group), 16 had a plate and free r adial forearm flap (FRFF group), and 14 had an osteocutaneous free nap. Fun ctionality, flap failure, and complications were scored. Results: Plates ha d to be removed in 7 of the 27 patients in the PMMF group and 2 of the 16 i n the FRFF group; none of the 14 osteocutaneous free Baps failed. The diffe rence was of borderline statistical significance (P = .055). Longterm funct ional outcome revealed no statistically significant difference in oral degl utition (P = .76) or in facial contour (P = .36). Oral continence was signi ficantly better in patients in the FRFF group (88%) as compared with the PM MF group (52%) or the osteocutaneous free flap group (43%) (P = .02). On th e other hand, the results for speech favored the osteocutaneous free flap g roup; 13 of 14 patients (92.9%) had a normal score compared with 12 of 16 p atients (75%) in the FRFF group and 17 of 27 (63%) in the PMMF group. Howev er, this represented a borderline statistically significant result (P = .66 ). Conclusions: For lateral mandibular defects, the osteocutaneous free nap is reliable and durable in the long term. However, in a selected group of patients either of the two flap-plate options is a viable reconstructive op tion.