Aims: Segmental resection with exarticulation of the lower jaw in oncological practice was performed in advanced oral cancer and primary tumors of the mandible. The main reasons of this operation are: significant bone destruction with a lesion of the mandibular channel, lesion of the mandible ramus in oral cancer and bone sarcomas. Prosthesis, revascularised bone flap and their combination are used for anatomical and functional rehabilitation. It is important to recreate the optimal positioning between the glenoid fossa and new “head” of the mandible and to achieve proper occlusion. Transplant fixation to the zygomatic bone or upper-mandible is an important part of the operation. CAD\CAM technology increases the accuracy of the reconstruction. The main complications of the prosthesis application are: migration of the head and extrusion through the skin, therefore the revascularised flaps are preferable. 

Materials and Methods: From 2003 to 2024 segmental resection of the mandible with exarticulation was performed at 75 patients with reconstruction of reconstruction plate and mandible head prothesis (14 patients (pt) (16.4%) and revascularised flaps (61 pt (83.6%). Cases with mandible prosthesis were excluded from the study. Primary tumors of the lower jaw (38 pt (62.3%)) malignant (29 pt (47.5%) or benign (9 pt (14.7%)) are the more frequent. Osteogenic sarcoma is the main primary tumor (20 pt (52.6%) of the mandible. In one case radioinduced osteogenic sarcoma after radiation therapy oral cancer was observed. Neoadjuvant chemotherapy is administered in 7 cases (35.0%) with stable disease in 5 (71.4%)) or partial response (2 (28.6%). Oral cancer (alveolar ridge or retromollar trigonum) with significant osseous destruction were observed in 23 cases (37.7%)). Body or ramus of the lower jaw are the most frequent involved parts of the mandible (51cases (83.6%)) and in 10 cases (16.4%) - subtotal lesion. Fibular osteomyocutaneous flap (56 pt (91.8%)) and iliac crest (5 pt (8.2%) pt) were used to reconstruct mandible and TMJ. CAD\CAM technology was applied in 31cases (50.8%). Restoration of TMJ was performed by the sutures between the distal end of the fibular flap and capsule of the TMJ. 

Results: Functional and aesthetic results are gratifying in 48 pt (78.7%). Restricted range of mouth opening motion is observed in 4 pt (6.5%) as 1 or 2 grade of trismus and one branch of facial nerve palsy in 3 pt (4.3%). Flap lost is observed in 6 cases (9.8%) due to insufficiency of the blood supply. 3-year overall survival rate is 59%. The main reason of unsatisfactory results are recurrences -17 cases (32.7%) (10 cases (43.5%) in oral cancer and 7 cases (24.1%) in sarcomas) and distant metastasis to the lungs in 6 cases (20.7%) in sarcomas, and only in 1 case (4.3%) in oral cancer. 1 death took place after adjuvant chemotherapy. The most remarkable progression was observed in osteogenic sarcoma of the mandible in 11 cases out of 20 (55.0%).

Conclusion: Revascularised fibular flap is a method of choice of mandible reconstruction after segmental resection in primary and secondary tumors (78.7%). TMJ reconstruction with the fixation of one end of the fibula to the capsule of the joint represents good functional and aesthetic results. The main reason of unsatisfactory results are the recurrences in oral cancer (43.5%) and lung metastasis in sarcomas (20.7%).

Mikhail A Kropotov is currently working as an oncologist at the head of the department at A. Tsyb Medical Radiological Research Center, Russian

Federation. He has specialized in the field of oncology, head and neck and radiation surgery. He has publised many research in a peer reviewed

journals.