Dental Implant Reconstruction of Fibular Free Flaps After Maxillofacial Oncologic Resection

Savannah L. Gelesko DDS, MD, Oral & Maxillofacial Surgery, Oregon Health & Science University, Portland, OR
R. Bryan Bell DDS, MD, FACS, Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, Portland, OR
Eric J. Dierks MD, DMD, FACS, FACD, Head and Neck Surgical Institute, Portland, OR
Bryce E. Potter DMD, MD, Head and Neck Surgical Associates, Portland, Oregon, Portland, OR
Tuan G. Bui DMD, MD, FACS, Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, Portland, OR
Problem: Determine whether dental implant reconstruction of maxillary and mandibular fibular free flaps is a viable treatment option for patients after undergoing head and neck oncologic ablation procedures.

Materials and Methods: This study is a multi-institutional retrospective chart review of all fibular flaps used for head and neck oncologic reconstruction over a 13 year period in Portland, OR at an academic practice based out of three private hospitals.  All patients who received fibular flaps for oromandibular reconstruction after head and neck cancer ablation over a 13 year period were identified.  The charts of those patients who received dentoalveolar implants in their fibular grafts were reviewed for implant and fibular flap complications.

Results:  201 patients received fibular flaps for head and neck oncologic reconstruction.  38 of these patients had complete charting and were restored with a total of 55 maxillary and 96 mandibular implants.  8 patients received radiation prior to flap placement.  8 mandibular implant failures in 2 patients were due to osteoradionecrosis. 2 mandibular implants failed on one patient due to fibular flap failure.  Two patients were unable to be restored due to severe postoperative trismus.   One patient was restored but was deceased due to metastatic lung disease.  5 maxillary implants failed due to incomplete osseointegration.  Overall there was a 7.5% implant failure rate, and a 9.9% complication rate.

Conclusion: Dental implant reconstruction of maxillary and mandibular fibular free flaps after head and neck oncologic ablation is a viable treatment option, but patients and physicians must be aware that there is a higher risk of complications and implant failure in this patient population.

References

1) Bell RB, Weimer KA, Dierks EJ, Buehler M, et al: Computer Planning and Intraoperative Navigation for Palatomaxillary and Mandibular Reconstruction with Fibular Free Flaps. J Oral Maxillofac Surg 69: 724-732, 2011.

2) Ferrari S, Coppelli C, Bianchi B, et al: Rehabilitation with endosseous implants in fibula free-flap mandibular reconstruction: A case series of up to 10 years. J Cranio-Maxillofac Surg 41:172-178, 2013.

See more of: Pre-Conference on Maxillofacial Oncology and Reconstructive Surgery
See more of: Maxillofacial Oncology and Reconstructive Surgery
See more of: Pre-Conference Program
<< Previous Abstract | Next Abstract >>