Presented as a podium presentation at the Triological Society Combined Sections Meeting in Scottsdale, Arizona, U.S.A. on January 25, 2013.
Facial Plastics/Reconstructive Surgery
Changing indications for maxillomandibular reconstruction with osseous free flaps: A 17-year experience with 620 consecutive cases at UCLA and the impact of osteoradionecrosis
Article first published online: 1 OCT 2013
© 2013 The American Laryngological, Rhinological and Otological Society, Inc.
Volume 124, Issue 6, pages 1329–1335, June 2014
How to Cite
Zaghi, S., Danesh, J., Hendizadeh, L., Nabili, V. and Blackwell, K. E. (2014), Changing indications for maxillomandibular reconstruction with osseous free flaps: A 17-year experience with 620 consecutive cases at UCLA and the impact of osteoradionecrosis. The Laryngoscope, 124: 1329–1335. doi: 10.1002/lary.24383
The authors have no funding, financial relationships, or conflicts of interest to disclose.
- Issue published online: 27 MAY 2014
- Article first published online: 1 OCT 2013
- Accepted manuscript online: 14 AUG 2013 08:59AM EST
- Manuscript Accepted: 5 AUG 2013
- Manuscript Revised: 21 JUN 2013
- Osseous free flap;
- microvascular reconstruction;
- segmental mandibulectomy;
- composite resection;
- vascularized bone-containing free tissue transfer;
- fibula free flap;
- maxillomandibular reconstruction
To characterize the changing indications for osseous free flaps in maxillomandibular reconstruction at our institution.
Retrospective chart review.
Database review of patients who underwent free-flap reconstruction of the jaws using vascularized bone-containing free tissue transfer from 1995 to 2012 at the University of California Los Angeles (UCLA).
A total of 620 osseous free flaps were performed. The most common indications for surgery were squamous cell carcinoma (n = 442) and osteoradionecrosis (ORN)) of the mandible (n = 73). There were no significant differences in 90-day perioperative complication, flap viability, or mortality rates between any of the indications for surgery. Patients older than 60 years had a higher rate of major perioperative complication (P = 0.0028). ORN cases represented 1.3% ± 1.2% of surgical volume from 1995 to 2000, 8.7% ± 1.8% from 2001 to 2006, and 17.5% ± 2.2% from 2007 to 2012 (P <0.0001). Among cases of ORN, 95.8% of patients had radiation therapy completed at centers outside of our hospital system. For patients with ORN, there was an average interval of 8.7 ± 8.0 years from initiation of radiotherapy to the date of mandibulectomy (range 1–37 years).
The incidence of ORN as an indication for free-flap reconstruction has increased at our institution in recent years. This may reflect an increasing need for the surgical management of medically refractory ORN, a rising awareness or prevalence of ORN overall, and/or increasing comfort with free flaps as a treatment for ORN. Patients who undergo free-flap surgery for ORN do not have greater risks of 90-day perioperative complications or differences in free-flap viability as compared to patients who undergo free-flap reconstruction for other indications.
Level of Evidence
2b. Laryngoscope, 124:1329–1335, 2014