Purpose

Osteoradionecrosis (ORN) of the mandible, a consequence of head and neck radiation, often necessitates extensive resections. While bony flap reconstructions (BFRs) are typically favored for patients with an intact condyle (Class I), the optimal approach for patients with a sacrificed condyle (Class II) remains uncertain. 

 

Methods

We conducted a 30-year retrospective analysis of mandibular ORNs with sacrificed condyles, from 994 to 2023, to compare the outcomes of BFRs versus soft-tissue flap reconstructions (SFRs).

 

Results

Among 74 cases, 46 (62%) underwent SFRs, Table . Although concomitant skin defects (Complex cases) were more common in SFRs (80% vs. 50%, p=0.006), SFRs had a significantly shorter operative time, Table 2. Donor, recipient, and microsurgical complications were similar between both groups. Nonetheless, in patients who did not tolerate a regular diet, SFRs were an independent predictor of tolerating soft rather than liquid diet (Odds ratio=00, p<0.00).

 

Conclusions

SFRs can aptly address complex Class II defects, requiring less operative time, and conferring a significant advantage in patients who fail to tolerate a regular diet postoperatively.