Rogers Ashton L, Farsi Soroush, Slater Noah, Gardner James R, King Deanne, Sunde Jumin, Vural Emre, Moreno Mauricio
Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, USA.
Cureus. 2024 May 11;16(5):e60103. doi: 10.7759/cureus.60103. eCollection 2024 May.
Introduction Head and neck cancer with mandibular invasion often necessitates composite resection, leading to defects requiring reconstruction. Microvascular fibula free flap (FFF) surgery is a common approach for this purpose. In this study, we focus on our experience with condyle sacrifice, emphasizing treatment outcomes and functional results. Additionally, we highlight a contemporary perspective by discussing surgical techniques and radiographic outcomes based on a 3D analysis of neo-condyle placement on CT imaging. Methods We studied 23 patients who had undergone segmental mandibulectomy requiring FFF reconstruction between 2009 and 2020. These were all performed by the same surgeon (M.M.) at an academic tertiary care center. Twenty-three reconstructions included condyle sacrifice. Retrospective chart review was performed with a focus on treatment, functional outcomes, and surgical technique. Results A total of 23 patients were included in the study group (13 females and 10 males) with a mean age of 58.1 years. The most common surgical indication was for oncologic purposes (n=9; 39.1%). Twenty (87%) patients required tracheostomy, and all were decannulated. In terms of surgical complications, two (8.7%) patients had a degree of arterial insufficiency and two (8.7%) developed delayed infections. The average inpatient stay was 5.61 days, with a subsequent average clinic follow-up after 16.9 days. CT or MRI imaging was available for 21 (91.3%) patients, showing 14 (66.7%) neo-condyles within the glenoid fossa. Fifteen (71.4%) patients had some element of anterior displacement (average=6.27 mm), and seven (33.3%) patients had a component of lateral displacement (average=2.23 mm). Three (13%) patients died during the follow-up period. Eighteen (90%) of the surviving patients returned to an oral diet within an average of 24.9 days. All patients returned to normal interincisal distance by 12 months. All FFFs, with and without complications, remained viable. Conclusion We achieved favorable oral function outcomes in the majority of our patients. Intriguingly, although radiographic evidence revealed anterior and/or lateral displacement of the neo-condyle, there was no observed correlation with the resumption of oral diet, trismus, or crossbite among these patients.
引言
伴有下颌骨侵犯的头颈癌通常需要进行联合切除术，从而导致需要重建的缺损。游离腓骨肌瓣（FFF）微血管手术是实现这一目的的常用方法。在本研究中，我们重点介绍髁突牺牲方面的经验，强调治疗结果和功能结果。此外，我们通过基于CT成像对新髁突位置的三维分析来讨论手术技术和影像学结果，突出当代观点。
方法
我们研究了2009年至2020年间接受需要FFF重建的节段性下颌骨切除术的23例患者。这些手术均由同一位外科医生（M.M.）在一家学术性三级医疗中心进行。23例重建手术包括髁突牺牲。通过回顾病历进行研究，重点关注治疗、功能结果和手术技术。
结果
研究组共纳入23例患者（13例女性和10例男性），平均年龄58.1岁。最常见的手术指征是肿瘤相关（n = 9；39.1%）。20例（87%）患者需要气管切开，且均已拔管。在手术并发症方面，2例（8.7%）患者出现一定程度的动脉供血不足，2例（8.7%）发生延迟感染。平均住院时间为5.61天，随后平均门诊随访时间为16.9天。21例（91.3%）患者可进行CT或MRI成像，显示关节盂内有14个（66.7%）新髁突。15例（71.4%）患者有一定程度的前移位（平均 = 6.27 mm），7例（33.3%）患者有侧方移位成分（平均 = 2.23 mm）。3例（13%）患者在随访期间死亡。18例（90%）存活患者平均在24.9天内恢复经口饮食。所有患者在12个月时恢复到正常切牙间距离。所有FFF，无论有无并发症，均保持存活。
结论
我们在大多数患者中取得了良好的口腔功能结果。有趣的是，尽管影像学证据显示新髁突有前移位和/或侧方移位，但在这些患者中未观察到与经口饮食恢复、张口受限或反牙合之间存在相关性。
