A Step-by-Step Approach to Free Fibula Flap Mandible Reconstruction of Mandibular Pathologic Fractures: A Pictorial Essay

Brian P Dickinson*, Nikkie Vu-Huynh, Monica B Vu, Amy Tsai, Timothy Kelley, George Semeniuk, Brian Kim, Craig Cox and Peter Ashjian

Background: Pathologic fractures of the mandible following radiation and embolization can be a challenging problem for patients. Occasionally, patients have already completed the oncologic component of their treatment and are trying to move on with their lives. A pathologic fracture is not only painful, but also a frustrating hindrance as it limits food intake and overall nutrition. In addition, pathologic fractures are challenging to repair.

Purpose: To demonstrate a step-by-step approach for pathologic mandibular fracture repair with an ipsilateral free fibula flap following oncologic resection of a tonsillar tumor that underwent pre-operative embolization and post-operative radiation therapy.

Methods/Results: A 65 year old male presented with a tonsillar head and neck tumor. The patient had pre-operative embolization for an intra-oral bleed, successful resection with clear margins, and then post-operative radiation therapy. During a subsequent dental procedure, the patient developed a pathologic mandibular fracture with subsequent pain and malocclusion including a posterior open bite. The pathologic mandible fracture was repaired with and ipsilateral free fibula flap. A chart review was completed to create a pictorial essay to describe our technique.

Conclusion: Successful repair of pathologic mandibular fractures can be rewarding for the operative surgeon and satisfying for the patient. Optimizing chances of success are improved with pre-operative CT scans and orthodontic models as well as intra-operative models. A step by step intraoperative approach is helpful for maximizing success and optimizing occlusion.

Keywords:

Published on: May 27, 2020 Pages: 52-57

Full Text PDF Full Text HTML DOI: 10.17352/2455-1759.000122
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