Treatment of extensive oromandibular defects following wide resection of head and neck cancer is challenging. In this report, we describe our basic considerations for extensive oromandibular reconstruction with free osteocutaneous flaps.
Preoperative evaluation：Surgeons must evaluate the cancer region by face-to-face examination. The location, size, and extent of the tumor should be assessed and the suspected surgical margin should be taken in consideration. Furthermore, remaining teeth following cancer resection should be evaluated for postoperative functional recovery.
Surgical planning：In general, a mandibular reconstruction plate or free vascularized osteocutaneous flap can be used. The method of oromandibular reconstruction should be determined by careful preoperative evaluation. Furthermore, the patient background, including preexisting comorbidities, social activities, and postoperative treatment plans, including radiotherapy and chemotherapy, should be taken into consideration. In addition, 3-dimensional surgical models are useful for preoperative surgical planning.
Surgical procedures：There are three representative osteocutaneous flap donor sites：the scapula, ilium, and fibula. Reconstructive surgeons must be familiar with these three flap surgeries. Of these, the vascularized fibula graft has several advantages such as having a long bone source, long vascular pedicle, and thin pliable skin paddle. Thus, the fibular graft can usually be the first choice for mandibular bone reconstruction.
In head and neck reconstruction, several plastic surgery techniques, including flap elevation, flap suturing, vascular anastomosis, bone graft, etc., are necessary for successful treatment. Moreover, surgical success and total recovery of postoperative function are required. Although head and neck reconstruction is challenging, surgery can be successful by improving basic knowledge and surgical techniques.
