PMC9674532_01
PMC9674532_02
A) facial view at the time of initial evaluation; B) 3D reconstruction computed tomography scan showing subtotal destruction of mandibular bone (arrow); C) postoperative photo after approximation of the lower face defect edges
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F1
There were massive lower face defects due to the loss of 21 cm of mandibular bone, its overlying soft tissue, the entire lower lip, the oral floor, and the lower surface of the anterior third of the tongue (Figure 1A). The head and neck computed tomography (CT) scan relieved subtotal mandibular destruction (Figure 1B). After general anesthesia, resuscitation with one litter of normal saline, antibiotic therapy, and blood products was initiated, then initial debridement and approximation of the lower face defect edges and tracheostomy were performed as initial emergency procedures (Figure 1C).
A) preoperative photo showing bone, soft tissue, and skin defects; B) intraoperative photo showing the location and preparation of osteocutaneous fibula-free flap; C) the osteocutaneous fibula-free flap after dissection and harvesting
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F2
Then, the bone and soft tissue and skin defects were estimated (21 cm for bone and 15x6 cm for skin and soft tissue) (Figure 2A). Design and mark OCFFF at the patient s right leg with bone length 21 cm, skin paddle 18x7 cm with aids of hand Doppler ultrasonography which was used to evaluate the site of skin perforators (Figure 2B). The OCFFF was harvested in the standard procedure described by Hidalgo (Figure 2C).
the results of flap coverage immediately after operation
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F3
Micro-anastomoses were made with one arterial and two veins anastomosis via interrupted 0.9 nylon sutures (Figure 3).
intraoperative photo showing the dental implantation
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F4
Five months later, the dental implantation was done for the lower jaw over the OCFFF (Figure 4).
photos at two years of postoperative follow-up; A) with a closed mouth; B) with an open mouth
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F5
The patient s speech was normal, and the aesthetic outcome was very good (Figure 5).