Novel Surgery Rebuilds Mandible Following Tumor Surgery

A novel surgical approach helps rebuild a functional lower jaw and mouth and preserve the ability to eat and speak after removing an invasive facial tumor, according to a new study.

Researchers at Henry Ford Hospital (Detroit, MI, USA) described a case of a 21-year-old African American male with a history of osteosarcoma that had spread to his lower jawbone three years after the initial diagnosis. The facial tumor soon grew to nearly 4.5 kg of tissue and bone, making it difficult for him to speak and eat, eventually requiring a feeding tube. The patient had previously undergone multiple treatments, including mandible resection, radiation, chemotherapy, and cryosurgery; all treatments were unsuccessful.

The surgeons at Henry Ford Hospital performed a near total mandibulectomy and removal of the tongue and mucous membrane from the inside of both cheeks and lower lip. The complex reconstruction of the face and jaw was then undertaken using dual microvascular free flaps from the left fibula and the subscapular area, a versatile donor system that offers mobility and a diverse range of skin, bone, and muscle available for use in reconstruction of massive facial defects. The study describing the procedure was presented as a poster session at the American Academy of Facial Plastic and Reconstructive Surgery annual meeting, held during September 2102 in Washington DC (USA).

“The bone tumor involved nearly all of his jaw bone, lower lip, chin, neck skin, tongue and both cheeks, approximately the lower third of the face and upper half of his neck,” said senior author and study presenter Tamer Ghanem, MD, PhD., director of the head and neck oncology and microvascular surgery division. “We had to think outside the box to not only safely remove the tumor, but to allow for optimum functional outcome.”

The researcher reported that only three months after the surgery the patient was able to talk and eat without assistance.

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