Abstract:

Objective: To investigate the effect of fibular free flap on reconstruction of postoperative defects after radiation-induced bilateral osteoradionecrosis of the jaw (ORNJ). Methods: Seven patients with radiation ORNJ who were referrd to Department of Oral and Maxillofacial Surgery in our hospital from January 2010 to November 2020 were retrospected. Among the cases, 6 males and 1 female, aged 42 to 56 years old, were included. All patients had primary nasopharyngeal carcinoma, and recurrent nasopharyngeal carcinoma was excluded. Fibular free flap was used to reconstruct bilateral osteoradionecrosis of the mandible. The fibular osteotomy and tissue flap survival, complications in donor and recipient areas, and postoperative mouth opening were evaluated for reconstruction outcomes. Results: After 10 to 30 months of follow-up, free fibular composite flap was successfully used to reconstruct mandibular defects. Facial artery was selected in 5 cases, superior thyroid artery in 2 cases, and end-to-side anastomosis of internal jugular vein was performed in all recipient veins. One patient developed venous crisis 6 hours after surgery. Emergency surgical exploration revealed that the vein was twisted during end-to-side anastomosis and recovered well after re-anastomosis. The harvested fibula was 17.5-21.0 cm in length. No patient had serious donor or recipient site complications. All patients had satisfactory facial shape, remaining normal occlusion, and mouth opening was 2.5-3.3 cm. Conclusion: Fibular myocutaneous flap can reconstruct the bilateral mandibular soft and hard tissue defects after radiation in patients with ORNJ, which is worthy of clinical application.

Key words: mandible, osteoradionecrosis of the jaw, fibular osteocutaneous flap, nasopharyngeal carcinoma

摘要：

目的： 探讨单侧腓骨皮瓣修复双侧下颌骨放射性颌骨坏死(osteoradionecrosis of the jaw，ORNJ)的应用价值。方法： 回顾性分析2010年1月至2020年11月，中南大学湘雅二医院口腔颌面外科采用单侧腓骨修复鼻咽癌放疗后双侧下颌骨ORNJ的7例患者的病例资料，其中男性6例，女性1例，年龄42~56岁，所有病例原发肿瘤均为鼻咽癌，排除鼻咽癌复发。记录腓骨截骨、组织瓣存活、供区和受区的并发症及术后开口度情况。结果： 随访10~30个月，7例患者皮瓣完全成活，伤口愈合良好，无严重并发症发生。受区动脉选择面动脉5例、甲状腺上动脉2例，受区静脉均行颈内静脉端侧吻合，1例患者术后6 h出现静脉危象，急诊手术探查，发现端侧吻合时静脉扭转，重新吻合静脉后恢复良好。切取腓骨长度为17.5~21.0 cm，平均18.2 cm，供区创口全部直接拉拢缝合，患者均未出现感染和跛行。术后双侧颜面部基本对称，患者对外形满意，开口度为2.5~3.3 cm。结论： 采用游离腓骨肌皮瓣移植修复双侧下颌骨ORNJ扩大切除术后软、硬组织缺损的方法安全可靠，值得临床推广应用。

关键词: 下颌骨, 放射性骨坏死, 腓骨肌皮瓣, 鼻咽癌