Adaptive Staged Surgical Protocol for Prosthetic Reconstruction for Osteoradionecrosis of the Jaws (ORNJ) and Comparison of its Functional Outcomes with Free Fibula Flap Reconstructions

Stephen Thaddeus Connelly, Davide Sozzi, Rishi Jay Gupta, Rebeka Silva, Shelley Miyasaki, Gianluca Martino Tartaglia*

Background: Reconstruction of full thickness mandibular defects with disarticulation due to ORNJ has traditionally been accomplished using vascularized free fibula flaps (FFF). But not all patients are candidates for FFF. A two-staged protocol (SPR) was developed taking into account the challenges of the surgical site and comorbidities of the patient utilizing custom prosthetics.

Methods: This study retrospectively analyzed 16 patients (13 males, 3 females) who developed stage III ORNJ subsequent to radiation and molar extraction (FFF n=4, SPR n=12). Postoperative surgical complications, maximal incisal opening (MIO), Pain Visual Analog Scale (VAS) at the different end points for the SPR and FFF group were analyzed.

Results: All patients demonstrated decrease in pain and increased mouth opening. Comparing Stage 1 SPR and FFF patients, there was a significant difference in pain, but not in function (1.89 ± 1.05 vs 0.25 ± 0.5, p<0.01 and 28.44 ± 8.10 vs 24.75 ± 1.26 p>0.20). After completion of the second stage surgery, there were significant differences in function, but not in pain in comparison to FFF patients (24.75 ± 1.26 vs 36.5 ± 8.37, p<0.026 and 0.25±0.5 vs 0.17±0.41, p>0.779).

Conclusion: Reconstruction of the temporomandibular joint with a custom prosthesis contributes to the significant improvement in function in the stage 1 SPR and in pain in stage 2 SPR versus the FFF.

Published Date: 2021-03-29; Received Date: 2021-03-08