Vascularized Fibular Flap for Reconstruction of the Condyle After Mandibular Ablation

González-García, Raúl; Naval-Gías, Luis; Rodríguez-Campo, Francisco J.; Martínez-Chacón, José L.; Gil-Díez Usandizaga, José L.

doi:10.1016/j.joms.2007.06.680

« Previous Next »Journal of Oral and Maxillofacial Surgery
Volume 66, Issue 6 , Pages 1133-1137, June 2008

Vascularized Fibular Flap for Reconstruction of the Condyle After Mandibular Ablation

Raúl González-García, MD
- Resident Surgeon, Department of Oral and Maxillofacial-Head and Neck Surgery, University Hospital La Princesa, Madrid, Spain.
- Address correspondence and reprint requests to Dr González-García: C/Los Yébenes 35, 8°C, 28047 Madrid, Spain
Luis Naval-Gías, MD, DMD, PhD
- Staff Surgeon, Chief of Oncology Division, Department of Oral and Maxillofacial-Head and Neck Surgery, University Hospital La Princesa, Madrid, Spain.
Francisco J. Rodríguez-Campo, MD
- Staff Surgeon, Department of Oral and Maxillofacial-Head and Neck Surgery, University Hospital La Princesa, Madrid, Spain.
José L. Martínez-Chacón, MD
- Staff, Department of Anesthesiology, University Hospital La Princesa, Madrid, Spain.
José L. Gil-Díez Usandizaga, MD
- Chairman of Section, Department of Oral and Maxillofacial-Head and Neck Surgery, University Hospital La Princesa, Madrid, Spain.

Purpose

The purpose of this study was to evaluate the outcome of the vascularized fibular free flap for the reconstruction of mandibular resections involving the condylar segment.

Patients and Methods

Six patients underwent mandibular resection including the condyle. Two patients were diagnosed with squamous cell carcinoma, whereas the other 4 presented fibrous dysplasia, mandibular osteoradionecrosis, mandibular ameloblastoma, and giant cell granuloma of the mandible. All of them underwent condylar reconstruction by means of transplant of the free fibular flap. In all the cases, the fibula was placed directly into the glenoid fossa. The temporomandibular disc was preserved over the pole of the fibula. Panoramic radiographs were performed postoperatively to evaluate condylar position and grade of bone resorption.

Results

Five patients developed adequate temporofibular function with absence of hypomobility and optimum interincisal opening, whereas 1 patient developed a temporofibular ankylosis with severe limitation of mandibular mobility and mouth opening.

Conclusions

The use of the fibula flap directly fitted into the glenoid fossa constitutes a reliable method in condylar reconstruction. However, the possibility of severe complications such as ankylosis has to be considered.