Abstract
Objective
Secondary reconstruction is requested by patients who have completed their head and neck cancer treatment. The reason for the request for reconstruction may be to improve the functional deficits, achieve aesthetic refinements or most commonly both. The article looks at various issues related to reconstruction in the secondary setting and suggesting the ways to approaching patients requesting secondary reconstruction.
Discussion
While considering secondary reconstruction, various factors need to be considered. These include issues related to the disease, the treatment received as well as the patient’s comorbid conditions. Aggressive disease and multiple recurrences should deter from undertaking complex reconstructions. Lack of tissue pliability resulting in a woody neck due to radiation makes dissection difficult and wound healing poor. The reconstructive requirements include release of contractures inside the mouth, reconstruction of the missing jaws, replacement of the missing volume of the tongue and correction of the incompetent angle of mouth. Goals of reconstruction should be prioritized by the surgical team. Free soft tissue or bone containing flaps would be provided ideal tissue to meet the reconstructive requirements in secondary reconstruction. However, several impediments could exist for their safe use. Release of contractures and provision of adequate soft tissue should be given priority and must be addressed before bony reconstruction is contemplated.
Conclusion
Bony reconstruction of both mandible and maxilla is possible, with the former being more difficult to deliver good results due to the associated soft tissue fibrosis. Virtual surgical planning with the aid of Stereo lithographic models and planning software will improve the quality of bony reconstruction. Detailed counseling sessions involving patient and the family are essential before embarking on secondary reconstruction as the patient expectations and the surgical outcome may not be easy to match. However excellent improvement in function and appearance will be possible in many patients with appropriate reconstructive procedure.
Similar content being viewed by others
References
Chim H, Salgado CJ, Seselgyte R, Wei FC, Mardini S (2010) Principles of head and neck reconstruction: an algorithm to guide flap selection. In Seminars in Plastic Surg 24(02):148–154
Ragbir M, Brown JS, Mehanna H (2016) Reconstructive considerations in head and neck surgical oncology: United Kingdom national multidisciplinary guidelines. J Laryngol Otol 130(S2):S191–S197
Ferretti C, Rikhotso E, Muthray E, Reyneke J (2013) Interim reconstruction and space maintenance of mandibular continuity defects preceding definitive osseous reconstruction. Br J Oral Maxillofac Surg 51(4):319–325
Kadam D (2019) Salvage secondary reconstruction of the mandible with vascularized fibula flap. Craniomaxillofac Trauma Reconstr 12(4):274–283
Stone HB, Coleman CN, Anscher MS, McBride WH (2003) Effects of radiation on normal tissue: consequences and mechanisms. Lancet Oncol 4(9):529–536
Halle M, Bodin I, Tornvall P, Wickman M, Farnebo F, Arnander C (2009) Timing of radiotherapy in head and neck free flap reconstruction–a study of postoperative complications. J Plast Reconstr Aesthet Surg 62(7):889–895
Miller MJ, Schusterman MA, Reece GP, Kroll SS (1994) Use of interposition vein grafts in head and microsurgery. J Reconstr Microsurg 10(2):133–134
Vieira L, Isacson D, Dimovska EO, Rodriguez-Lorenzo A (2021) Four lessons learned from complications in head and neck microvascular reconstructions and prevention strategies. Plastic Reconstruct Surg Global Open. 9(1):e3329
Frohwitter G, Rau A, Kesting MR, Fichter A (2018) Microvascular reconstruction in the vessel depleted neck–A systematic review. J Cranio-Maxillofac Surg 46(9):1652–1658
Breik O, Praveen P, Parmar S (2020) The vessel-depleted neck in head and neck microvascular reconstruction: extreme solutions for extreme situations. Curr Opin Otolaryngol Head Neck Surg 28(2):129–135
Haubner F, Ohmann E, Pohl F, Strutz J, Gassner HG (2012) Wound healing after radiation therapy: review of the literature. Radiat Oncol 7(1):1–9
Herle P, Shukla L, Morrison WA, Shayan R (2015) Preoperative radiation and free flap outcomes for head and neck reconstruction: a systematic review and meta-analysis. ANZ J Surg 85(3):121–127
Du E, Patel S, Huang B, Patel SN (2019) Dual-phase CT angiography for presurgical planning in patients with vessel-depleted neck. Head Neck 41(9):2929–2936
Chang EI, Boukovalas S, Liu J, Largo RD, Hanasono MM, Garvey PB (2019) Reconstruction of posterior mandibulectomy defects in the modern era of virtual planning and three-dimensional modeling. Plast Reconstr Surg 144(3):453e-e462
Ciocca L, Mazzoni S, Fantini M, Persiani F, Marchetti C, Scotti R (2012) CAD/CAM guided secondary mandibular reconstruction of a discontinuity defect after ablative cancer surgery. J Cranio-Maxillofac Surg 40(8):e511–e515
Mardini S, Chang YM, Tsai CY, Coskunfirat OK, Wei FC (2006) Release and free flap reconstruction for trismus that develops after previous intraoral reconstruction. Plast Reconstr Surg 118(1):102–107
Colletti G, Autelitano L, Tewfik K, Rabbiosi D, Biglioli F (2012) Autonomized flaps in secondary head and neck reconstructions. Acta Otorhinolaryngol Ital 32(5):329
Henn D, Nissen A, Menon N, Lee GK (2015) Restoration of oral competence in double free flap reconstructions of massive lower facial defects with fascia lata slings–Case series and review of the literature. Case Rep Plastic Surg Hand Surg 2(3–4):67–72
Yamakawa S, Hayashida K (2021) Safety and efficacy of secondary mandibular reconstruction using a free osteo-cutaneous fibula flap after segmental mandibular resection: a retrospective case–control study. BMC Surg 21(1):1–9
Kumar BP, Venkatesh V, Kumar KA, Yadav BY, Mohan SR (2016) Mandibular reconstruction: overview. J Maxillofac Oral Surg 15(4):425–441
Dowgierd K, Pokrowiecki R, Borowiec M, Kozakiewicz M, Smyczek D, Krakowczyk Ł (2021) A protocol for the use of a combined microvascular free flap with custom-made 3d-printed total temporomandibular joint (TMJ) prosthesis for mandible reconstruction in children. Appl Sci 11(5):2176
Wang Y, Qu X, Jiang J, Sun J, Zhang C, He Y (2021) Aesthetical and accuracy outcomes of reconstruction of maxillary defect by 3D virtual surgical planning. Front Oncol 19(11):718946
Acknowledgements
The authors acknowledge the support received from Department of Head and Neck Surgery, Department of Plastic and Reconstructive Surgery and Department of Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences, Kochi.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
None.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Iyer, S., Ramu, J. & Krishnadas, A. Secondary Reconstruction of Head and Neck Cancer Defects—Principles in its Practice. J. Maxillofac. Oral Surg. 22 (Suppl 1), 1–9 (2023). https://doi.org/10.1007/s12663-023-01875-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12663-023-01875-x