Virtual Surgical Planning Facilitates Surgical Resection in Mandibular Osteoradionecrosis and Optimize Reconstructive Outcomes

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Background: Mandibular osteoradionecrosis (ORN) is a devastating complication of radiotherapy for oropharyngeal malignancy. Despite advancements in ORN treatment, risk of ORN recurrence remains high following surgical resection. Virtual surgical planning (VSP) for ORN treatment is an evolving application that may not only inform bony reconstruction but also therapeutic surgical margins, which remain inconclusively defined in the literature. Methods: A retrospective review was performed of 25 cases in which patients underwent VSP-guided resection of mandibular ORN followed by immediate free fibula flap reconstruction. Surgical margins of 1-cm from radiologically evident disease were taken. VSP accuracy was quantified by comparing measured anatomic parameters between the virtually planned outcomes and the final outcomes on postoperative imaging. Statistical analyses were performed to assess associations between preoperative factors and postoperative complications including ORN recurrence. Results: The mandibular body was most frequently affected by ORN in this series of patients. Among risk factors, only the presence of a preoperative orocutaneous fistula was predictive of a complication, specifically partial flap failure (β = 1.41; P =.013). Intended anatomic parameters were achieved with the exception of the intergonial distance (x difference = 0.53 cm; P =.03). Finally, there were no cases of ORN recurrence after a mean follow-up of 27.4 months. Conclusions: VSP of free fibula flaps for mandibular reconstruction following ORN is a valid tool for effecting accurate anatomical outcomes. Furthermore, we demonstrate that a 1-cm margin around radiographically evident ORN may effectively implement a curative outcome free from relapse.

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