Immediate Microsurgical Bone and Nerve Reconstruction in the Radiated Patient: A Case Report

Publication date: Available online 11 December 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Ramzey Tursun, J Marshall Green
Microsurgical reconstructive techniques have revolutionized the treatment of large head and neck defects. These defects were once forever life altering due to the significant morbidity to both the form and function of the patient. As time has progressed microsurgical technique has improved dramatically and has become institutionalized in our training programs. Free flap outcomes in head and neck reconstruction have improved dramatically and optimization of these outcomes is now key. One overlooked area has been neurosensory reconstruction. In our practice we have focused on this detail which has proven to be quite important to the patient. This case report details one such case in which a mandibular resection was performed to treat osteoradionecrosis. We, as the reconstructive team, elected to perform a double barrel fibular free flap with simultaneous inferior alveolar nerve reconstruction utilizing a 70 cm processed nerve allograft. This patient went on to have a return to normal neurosensory function. As the state-of-the-art advances with continued successful osseous and soft tissues reconstruction in the head and neck we propose concomitant neurosensory functional reconstruction always be considered.



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