Novel use of temporoparietal fascial flap in mandibular osteoradionecrosis.

Abstract

Background Mandibular osteoradionecrosis following treatment for head and neck malignancies leads to pain and pathological fractures, significantly affecting quality of life. Definitive surgical treatment involves resection of the necrotic segment and reconstruction using a vascularised tissue free flap, with a fibula free flap being the most common option. This, however, carries the risk associated with free tissue transfers and the additional donor site morbidity. We describe the novel use of a temporoparietal fascial flap (TPFF) in the management of mandibular osteoradionecrosis. Methods A 53-year old patient with a T2N2b SCC of the oral cavity, underwent a partial glossectomy and neck dissection followed by chemoradiotherapy. Two mandibular dental extractions were performed three years later, leading to osteoradionecrosis with an orocutaneous fistula, worsening pain and a mid-body pathological fracture. This failed conservative treatment. Patient was not keen for a protracted admission and the expected rehabilitation following definitive treatment described above. We performed debridement of the necrotic bone, excision of the fistula tract and a TPFF to cover the defect. Results Oral intake was introduced on post-operative day 4 and the patient was discharged home on day 7. There were no donor site complications. The patient is currently pain free, with an unrestricted diet and no further issues with oral infections or fistulas. Repeat CT of the mandible at one year following surgery revealed a stable pathological fracture. Conclusion TPFF was successful in stabilising mandibular osteoradionecrosis and improving patient