Primary reconstruction of a mandible and facial nerve defect using a combined flap consisting of a scapular osteocutaneous flap and a latissimus dorsi muscular flap

Abstract

A 50-year-old female with a right mandibular squamous cell carcinoma diagnosed as T4N1 underwent rt. partial mandibulotomy with resection of the total layer of the cheek and a rt. functional neck dissection. As a result, the mandible and rt. lower branch of the facial nerve were damaged. Therefore, a scapular osteocutaneous flap and a latissimus dorsi muscular flap, including the thoracodorsal nerve were elevated as a combined flap. The mandibular bone, oral mucosa and cheek skin were reconstructed using a scapular-parascapular bilobed skin flap with the sacpular bone. To restore function of the lower branch of the facial nerve, the thoracodorsal nerve of the latissimus dorsi muscular flap was sutured to the proximal end of the resected lower branch of the facial nerve, while the distal end of the latissimus dorsi muscular flap was divided and sutured to the muscle around the lip. The postoperative function and shape of the mandible were both found to be satisfactory. Moreover, lip movement was recognized 6 months after the operation. We thus conclude that the combined flap consisting of a scapular osteocutaneous flap and a latissimus dorsi muscular flap is useful for simultaneous reconstruction of the mandible and lower branch of the facial nerve.