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Review | Journal Club

Reconstruction of the Lateral Mandibular Defect A Review and Treatment Algorithm

Yelizaveta Shnayder, MD1; Derrick Lin, MD2; Shaun C. Desai, MD3; Brian Nussenbaum, MD3; Jordan P. Sand, MD3; Mark K. Wax, MD4
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, University of Kansas School of Medicine, Kansas City
2Division of Head and Neck Oncology, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston
3Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
4Department of Otolaryngology–Head and Neck Surgery, Oregon Health Sciences University, Portland
JAMA Facial Plast Surg. 2015;17(5):367-373. doi:10.1001/jamafacial.2015.0825.
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Reconstruction of the lateral mandibular defect presents a complex challenge to the reconstructive surgeon, often involving interconnected soft-tissue and bone requirements. This review examines the current literature on functional outcomes of lateral mandibular reconstruction and presents an algorithm on selecting an optimal reconstructive choice for patients with lateral mandibular defects resulting from oncologic ablative surgery or trauma. PubMed and Medline searches on reconstructing lateral mandibular defect were performed of the English literature. Search terms included lateral mandibular defect, outcomes of mandibular reconstruction, and free flap reconstruction of mandible. Although most of the articles presented are retrospective reviews, priority was given to the articles with high-quality level of evidence. Restoration of function, including speech and swallow, and acceptable cosmetic result are the primary objectives of lateral mandibular reconstruction. When reconstructing the mandible in a patient following tumor extirpation, the patient’s overall prognosis, medical comorbidities, and need for adjuvant therapy should be considered. In the patient with aggressive malignant disease and a poor prognosis, a less complex reconstruction, such as soft-tissue flap with or without a reconstruction plate, may be adequate. In a dentate patient with favorable prognosis, a durable reconstruction, such as osseocutaneous microvascular free flap, is often preferred. Various reconstructive options are available for patients with lateral mandibular defects. Depending on the predominance of the soft-tissue or bony components of the defect, with consideration of the patient’s characteristics and functional and aesthetic goals, the surgeon can wisely select from these reconstructive possibilities.

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Figure 1.
Bony Reconstruction

A, Panorex of a bony union of mandibular defect reconstructed with osteocutaneous radial forearm free flap 4 years postoperatively. B, Computed tomographic scan of the same patient.

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Figure 2.
Algorithm for Lateral Mandibular Defect Reconstruction

aMinor soft-tissue defects are those that have low volume and are adjacent to the bone defect (ie, floor of mouth detect only).

bMajor soft-tissue defects are that have high volume and involve multiple anatomic subsites with complex 3-dimensional anatomy (ie, subtotal oral glossectomy or hemipalatectomy).

cExtraoral soft-tissue defects in combination with mandibular bone are typically created during a radical parotidectomy or deep skin cancer resection.

dIdeal reconstruction refers to the surgical option that could provide the most optimal reconstruction; however, it may not always be possible.

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