Free-flap iliac crest in mandibular reconstruction following segmental mandibulectomy for squamous cell carcinoma of the oral cavity

The aim of the study was to asses the anatomic and functional results and quality of life of a cohort of patients submitted to immediate reconstruction with the iliac osteomusculocutaneous free flap following composite resection for carcinoma of the oral cavity. Twelve patients affected by squamous cell carcinoma of the oral cavity were submitted to a single surgical procedure that included a segmental mandibulectomy in a composite resection, followed by primary reconstruction using a vascularized bone-containing free flap of the iliac crest. Reconstruction failed in one patient. Functional results as well as quality of life of 10/12 patients were evaluated using the Performance Status Scale and Functional Assessment Cancer Therapy General Scale questionnaires, appropriately modified for the pathology. The results were compared with those obtained in a group of five patients who underwent composite resection for oral carcinoma without mandibular reconstruction. Patients submitted to reconstruction noted a greater physical well being (score 22/78% vs. 16/53%; max. 28/100%), socio-family relationships (score 23/81% vs. 18/64%; max. 28/100%), emotional (score 18/90% vs. 14/70%; max. 20/100%) and general functional well-being (score 24/86% vs. 14/50%; max. 28/100%). Better recovery in functional mastication and swallowing was also observed (score 17/70% vs. 9/37%; max. 24/100%). A follow-up of longer than 6 months showed minimal donor site morbidity.