| Autor: |
Shpitzer, Thomas, Gullane, Patrick J., Neligan, Peter C., Irish, Jonathan C., Freeman, Jeremy E., Van den Brekel, Michiel, Gur, Eyal |
| Zdroj: |
Laryngoscope; 2000, Vol. 110 Issue 12, p2056-2060, 5p |
| Abstrakt: |
Objectives/Hypothesis Reconstruction of the mandible and oral cavity after segmental resection is a challenging surgical problem. Although osteocutaneous free flaps are generally accepted to be optimal for reconstruction of anterior defects, the need for bony reconstruction for a pure lateral mandibular defect remains controversial. Study Design A retrospective study. Methods A retrospective comparative study of short- and long-term outcomes of three different reconstruction techniques for lateral defects was performed. In total, 57 patients were included, of whom 27 had a plate and pedicled pectoralis major myocutaneous flap (PMMF group), 16 had a plate and free radial forearm flap (FRFF group), and 14 had an osteocutaneous free flap. Functionality, flap failure, and complications were scored. Results Plates had to be removed in 7 of the 27 patients in the PMMF group and 2 of the 16 in the FRFF group; none of the 14 osteocutaneous free flaps failed. The difference was of borderline statistical significance ( P = .055). Long-term functional outcome revealed no statistically significant difference in oral deglutition ( P = .76) or in facial contour ( P = .36). Oral continence was significantly better in patients in the FRFF group (88%) as compared with the PMMF group (52%) or the osteocutaneous free flap group (43%) ( P = .02). On the other hand, the results for speech favored the osteocutaneous free flap group; 13 of 14 patients (92.9%) had a normal score compared with 12 of 16 patients (75%) in the FRFF group and 17 of 27 (63%) in the PMMF group. However, this represented a borderline statistically significant result ( P = .06). Conclusions For lateral mandibular defects, the osteocutaneous free flap 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 option. [ABSTRACT FROM AUTHOR] |
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