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Multicenter Study
. 2024 Nov;46(11):2824-2833.
doi: 10.1002/hed.27824. Epub 2024 Jun 7.

Microvascular reconstruction of midface osteoradionecrosis

Larissa Sweeny  1   2 , Neeraja Konuthula  1 , Ryan Jackson  3 , Mark K Wax  4 , Joseph M Curry  5 , Sara Yang  4 , Dev Amin  5 , Anne C Kane  6 , Steve B Cannady  7 , Kendall Tasche  8 , Michael DiLeo  9 , Daniel Lander  3 , Alexandra E Kejner  10 , Patrik Pipkorn  3
Affiliations
Multicenter Study

Microvascular reconstruction of midface osteoradionecrosis

Larissa Sweeny et al. Head Neck. 2024 Nov.

Abstract

Background: Head and neck osteoradionecrosis (ORN) of the midface requiring free flap (FF) reconstruction is uncommon. This multi-institutional study was designed to review outcomes for this rare patient population.

Methods: Retrospective multi-institutional review of FF reconstruction for midface ORN (2005-2022; n = 54).

Results: The FF survival rate was 87% (n = 54). Patients were less likely to be tolerating a regular diet at 3 months postoperative if they had a preoperative history of prior head and surgery (80% vs. 95%; p = 0.02), a pathologic fracture (50% vs. 90%; p = 0.04), exposed bone intraorally (43% vs. 94%; p = 0.002), or a fistula (67% vs. 96%; p = 0.03). Mean albumin was higher in patients whose FF survived (3.6 ± 0.5 vs. 2.7 ± 1.4; p = 0.03). Patients with low prealbumin were more likely to undergo a hematoma evacuation (27% vs. 0%; p = 0.02).

Conclusion: In this series of midface ORN requiring FF reconstruction preoperative nutritional status impacted postoperative complications. Preoperative occurrence of a fistula, pathologic fracture, and intraoral bone exposure correlated with decreased tolerance of a regular diet following reconstruction.

Keywords: free flap; head and neck reconstruction; midface; osteoradionecrosis; outcomes.

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References

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