Worldwide 10-Year Systematic Review of Treatment Trends in Fibula Free Flap for Mandibular Reconstruction

doi:10.1016/j.joms.2016.06.170

Journal of Oral and Maxillofacial Surgery

Volume 74, Issue 12, December 2016, Pages 2526-2531

https://doi.org/10.1016/j.joms.2016.06.170 Get rights and content

Purpose

The purpose of this study was to describe the trends pertaining to the use of the fibula free flap for mandibular reconstruction during the past 10 years.

Materials and Methods

A systematic review for publications on the fibula free flap in mandibular reconstruction in the PubMed and Scopus databases was performed from January 1, 2005 until December 31, 2014. Publications were classified by topic, number of patients, and country of origin. The study period was split into 2 periods. The first 5-year period was compared with the second 5-year period.

Results

Eighty-five publications were identified. There was an increase in publications regarding restorative decision making (11 vs 9), surgical techniques (13 vs 6), outcomes (20 vs 10), and computer-aided design and computer-aided manufacturing (CAD-CAM; 8 vs 2) in the second 5-year period. The number of patients reported also increased in publications on surgical techniques (1,085 vs 59), outcomes (777 vs 254), bisphosphonate-related osteonecrosis of the jaw and osteoradionecrosis (165 vs 28), and CAD-CAM (65 vs 15) in the second 5-year period. The United States, India, China, and Europe produced most of the publications.

Conclusions

In the past 10 years, there was a surge in publications on the use of the fibula free flap for mandibular reconstruction. There was a 1.8-fold increase in the number of publications and a 3.4-fold increase in the number of patients undergoing this method of mandibular reconstruction in the second 5-year period. Publications from the United States, India, and China contributed to a large increase in the number of patients in the second 5-year period. More interest in CAD-CAM technology was seen in the second 5-year period that was not seen in the first 5-year period.

Section snippets

Materials and Methods

The authors performed a systematic review of the literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Declaration of Helsinki.⁴ A systematic search of 2 databases (PubMed and Scopus) was performed using the search keywords (fibula [title] AND (mandible [title] OR mandibular [title]) AND reconstruction [title]). Publications from January 1, 2005 until December 31, 2014 were included. Only case series or studies of at

Results

The flowchart of inclusion and exclusion criteria (Fig 1) shows that 85 publications were available for descriptive analysis. The total number of patients reported for all these publications was 3,080. From 2005 to 2009, 30 publications on 696 patients were published, and from 2010 to 2014, 55 publications on 2,384 patients were published. The publications were in 20 different journals from 2005 to 2009 and in 30 different journals from 2010 to 2014.

The breakdown per study period for the

Discussion

The authors identified an increase in the number of publications related to fibula free flap for mandibular reconstruction in the second half of the 10-year period (55 vs 30). Based on these results, some factors could explain this increase. First, there has been an increase in the number of scientific journals that publish these types of studies, making publishing more accessible to researchers. The number of scientific journals has been increasing at the steady rate of 3.5% per year for the

Acknowledgment

The authors thank Eliza Dewey, BA, and Cathy Lazarus, PhD, for their assistance in this publication.

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Citation Excerpt :
Such unsuccessful attempts may bring suffering in terms of cosmesis, mastication, and speech17,18. To avoid these possible mistakes, several aspects need to be considered before surgical implementation, such as treatment history, comorbidity, length and height of the bony defect, location, nearby soft tissue, available recipient and donor sites, types of reconstruction, and subsequent rehabilitation1–4,19–22. In order to achieve a better re-do reconstructive result, there are several factors to consider in the preoperative planning and intraoperative execution.
Unsuccessful mandibular reconstruction occasionally occurs, leaving the patient with undesirable function and contours. In such cases, second- or third-time corrective operations are challenging. However, published studies on the complicated retreatment of such patients are scarce. A retrospective analysis covering the years 2015–2019 was conducted in three centers. All 17 patients included had undergone prior failed mandibular reconstructions in other institutions. Salvage secondary or tertiary reconstructive surgeries were attempted and the results are presented. Major factors for these failed reconstructions included exposed non-vascularized bone grafts (n = 7, 41.2%), flap loss (n = 4, 23.5%), exposed artificial joint (n = 3, 17.6%), skewed occlusion with deformity (n = 1, 5.9%), non-union (n = 1, 5.9%), and recurrence (n = 1, 5.9%). Fibula flaps were transferred in 15 patients, while iliac flaps were used in two patients for mandibular re-do reconstructions. Virtual surgical designs were conducted in nine (52.9%) patients, with navigation-guided approaches performed in three cases. Postoperative functions were relatively favorable in these complicated mandibular re-do reconstruction cases. Mandibular symmetry (mandibular length and height; P = 0.002) and condylar position (P < 0.001) were regained after these re-do attempts. Secondary or tertiary mandibular re-do reconstruction can still achieve good functional outcomes with appropriate preoperative selection and well-conceived designs, especially with the aid of virtual surgery and navigation.
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Surgical oncology and reconstructionWorldwide 10-Year Systematic Review of Treatment Trends in Fibula Free Flap for Mandibular Reconstruction

Purpose

Materials and Methods

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

Acknowledgment

Oral Oncol

Oral Oncol

J Oral Maxillofac Surg

Oromandibular reconstruction using microvascular composite flaps: Report of 210 cases

Arch Otolaryngol Head Neck Surg

Osteocutaneous free flaps for mandibular reconstruction: Systematic review of their frequency of use and a preliminary quality of life comparison

J Laryngol Otol

Fibula free flap: A new method of mandible reconstruction

Plast Reconstr Surg

Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA statement

PLoS Med

The STM Report—An Overview of Scientific and Scholarly Journals Publishing

Challenges of the oral cancer burden in India

J Cancer Epidemiol

Surgical oncology and reconstruction
Worldwide 10-Year Systematic Review of Treatment Trends in Fibula Free Flap for Mandibular Reconstruction