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Fascio-cutaneous and fascio-periosteal free flaps for treatment of intermediate stage osteoradionecrosis of the jaws.Preliminary results

  • Michael J L Hurrell
    Correspondence
    Corresponding author: Dr Michael Hurrell, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown NSW
    Affiliations
    Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
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  • Tsu-Hui (Hubert) Low
    Affiliations
    Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia

    Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia

    Department of Otolaryngology – Head and Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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  • Sydney Ch'ng
    Affiliations
    Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia

    Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia

    Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
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  • Jonathan R Clark
    Affiliations
    Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia

    Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia

    Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
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Published:December 17, 2022DOI:https://doi.org/10.1016/j.oooo.2022.12.002

      Abstract

      Background

      Osteoradionecrosis (ORN) of the jaw is a potentially devastating consequence of head and neck irradiation. Despite recent advances, there are patients who fail to respond to conventional therapies. Historically, free flaps were reserved for advanced cases requiring segmental resection and composite reconstruction, with early and intermediate disease treated with more conservatively. We have adopted a more active surgical approach in selected intermediate cases.

      Methods

      A retrospective review of patients with intermediate stage ORN who received debridement and either fascio-cutaneous or fascio-periosteal free flap reconstruction was performed. Demographic data, ORN severity, treatment, and outcomes are described.

      Results

      From 2019, nine cases in seven patients were identified. All cases were Notani grade II. There were six Epstein stage IIa and three Epstein stage IIIa. The mandible was the most common site (n = 8). Of the seven patients, two had oropharyngeal primaries treated with chemoradiation, five had oral cavity primaries treated with surgery and adjuvant radiation therapy. Three patients had prior hyperbaric oxygen therapy, and two had pentoxifylline/tocopherol therapy. Following debridement, the radial forearm, ulnar artery perforator and antero-lateral thigh fascio-cutaneous free flaps were each used in one case and the temporoparietal fascio-periosteal free flap was used in six cases. There was no recurrence or progression of ORN at the site of surgery, however two patients developed additional sites of ORN.

      Conclusions

      For patients with unresponsive intermediate ORN, debridement and soft-tissue free flap reconstruction is an alternative to ongoing conservative management or composite resection and reconstruction.
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