Reconstruction of the marginal mandibulectomy defect: an update

ObjectiveThe purpose of this study is to provide an update to the reconstructive management of the marginal mandibulectomy defect.Study designTwenty-six consecutive patients were retrospectively reviewed.MethodsPatient and tumor variables were extracted from the medical record. Outcomes that were examined included method of reconstruction, frequency of osteoradionecrosis, and resumption of an oral diet.ResultsFifteen (57.7%), 8 (30.8%), and 3 (11.5%) patients were reconstructed with a skin graft, primary closure, or a radial forearm free flap, respectively. Indications for a radial forearm free flap were reconstruction of an associated subtotal glossectomy defect, a through-and-through cheek defect, and a maxillectomy defect. Five patients reconstructed with a skin graft also received postoperative radiation therapy. One (20%) developed osteoradionecrosis. Excluding patients with recurrent tumors (n = 5) or osteoradionecrosis (n = 1), all patients at last follow-up were maintaining an oral diet.ConclusionsSkin graft remains a preferred method of reconstruction for the marginal mandibular defect. A free flap is reserved for those marginal defects where additional soft tissue is needed to reconstruct subtotal glossectomy defects or defects of the midface and/or maxilla. Because of the potentially increased risk of osteoradionecrosis, reconstruction with a free flap instead of a skin graft should be considered if a patient will receive postoperative radiation therapy.