Enhanced Functional Outcomes in Mandibular Reconstruction: Suggests Study

Mandibular reconstruction following oncologic resection is a complex clinical challenge, and while microvascular free flaps are often preferred, a significant clinical gap exists for patients with medical comorbidities or financial constraints who require reliable, less resource-intensive alternatives. To address this, Chandrashekar Bande and colleagues from the Department of Oral and Maxillofacial Surgery in Central India conducted a study to determine if the Pectoralis Major Myocutaneous (PMMC) flap alone or in combination with a reconstruction plate (RP) provides better postoperative stability and functional recovery.

Therefore, the retrospective study (2021–2024) evaluated 36 male patients (mean age 42) with advanced oral squamous cell carcinoma (Stage III/IV) undergoing segmental mandibulectomy. Patients received either a Pectoralis Major Myocutaneous (PMMC) flap alone (Group A) or integrated with a reconstruction plate (Group B). Primary endpoints focused on surgical complications like suture dehiscence and fistula formation, while secondary outcomes assessed speech intelligibility and nutritional recovery over a six-month follow-up.

• Improved Nutritional Recovery: Patients in Group B achieved better functional outcomes, with 61.11% reaching normal oral intake compared to 50% in Group A, according to the study.

• Reduced Soft Tissue Complications: While Group A experienced significant complications, including orocutaneous fistula formation in 22.2% and suture line separation in 16.6% of cases, the combined approach in Group B demonstrated a more stable healing profile.

• High Structural Integrity: The study noted that 83.33% of patients in Group B retained their reconstruction plates without any postoperative complications, though a minor 5.55% did experience a plate fracture.

• Enhanced Aesthetic Satisfaction: Clinical assessments revealed that the use of a reconstruction plate in Group B generally provided superior aesthetic and functional results for patients undergoing extensive mandibular resection.

The results suggest that the combination of a PMMC flap and a reconstruction plate is a practical and effective alternative for mandibular reconstruction, particularly in patients with medical or financial limitations, as it offers favorable functional outcomes with fewer complications and reduced operative time.

Thus, the study concludes clinicians may find that the integrated use of a reconstruction plate with a PMMC flap provides a reliable secondary reconstructive strategy when microvascular options are not feasible.

The study was limited by its retrospective design and the specific demographic of the study population, indicating that further research is needed to validate these findings across broader and more diverse patient groups.

Reference