RESECTION AND IMMEDIATE MICROVASCULAR RECONSTRUCTION IN THE MANAGEMENT OF OSTEORADIONECROSIS OF THE MANDIBLE

Background. Management of osteoradionecrosis (ORN) remains a difficult and challenging problem. The traditional approach using debridement, antibiotics, and occasionally hyperbaric oxygen is usually successful in treating minimal ORN. However, when bone and soft-tissue necrosis i s extensive, the conservative approach usually requires intensive care over a long period of time and often yields unsatisfactory functional and cosmetic results. Methods. Within the past 5 years, we have used radical resection of the mandible with immediate microvascular reconst ruction in the treatment of extensive ORN of the mandible. This aggres sive surgical approach was used in six patients with advanced ORN of t he mandible, all of whom had failed initial conservative treatment, in cluding hyperbaric oxygen therapy in three. A fibular free graft with microvascular anastomosis was used in all patients. Results. All the p atients healed primarily with minimal postoperative morbidity and exce llent cosmetic results. Two patients subsequently required removal of some of their hardware. One patient had placement of osseointegrated i mplants with an excellent cosmetic and functional result. Conclusion. Microvascular reconstruction with its own blood supply seems to expedi te bone healing and limit further osteoradionecrosis of the remaining mandible. Although prevention is the primary goal in radiation injury, our experience suggests that radical resection with free microvascula r reconstruction offers significant advantages to selected patients wi th extensive ORN of the mandible. (C) 1997 John Wiley & Sons, Inc.