The rationale of mandible reconstruction in advanced oral cancer: Alloplastic material versus autogenous vascularized bone graft

Autogenous vascularized bone grafts in combination with microsurgical techniques have revolutionized mandibular reconstruction in oral cancer surgery. The vascularized bone graft carries its own blood supply, resists infection, and heals rapidly even in the irradiated bed. However, its use in advanced oral cancer patients is controversial due to the gloomy prognosis of these patients. Effective alloplastic materials such as titanium plate or tray for mandibular reconstruction is a reasonable alternative. These can easily be shaped and have sufficient structural rigidity to maintain the mandibular fragments in proper orientation. Likewise, it is a fast and reliable procedure which can obtain good oral function. However, its potential late exposure due to breakdown of overlying skin, especially after radiotherapy, is well documented. This paper discusses our experience to rescue the oral function after alloplastic material failure using the vascularized fibula osteocutaneous flap, in irradiated patients. All fibula osteocutaneous flaps survived. Symmetry and contour of the reconstructed mandible were judged to be good, and patients were able to eat without saliva drooling. Donor-site morbidity was also low. From this clinical study, we believe that in advanced oral cancer, the titanium plate or tray is a useful adjunct for immediate mandibular reconstruction after surgical resection. The vascularized bone graft should be reserved for patients with alloplastic material failure. This rationale can avoid subjecting the patient to an unnecessary extensive mandibular reconstructive procedure.