Adaptive Staged Surgical Protocol for Prosthetic Reconstruction for Osteoradionecrosis of the Jaws (ORNJ) and Comparison of its Functional Outcomes with Free Fibula Flap Reconstructions

Background: Reconstruction of full thickness mandibular defects with disarticulation due to ORNJ has traditionally been accomplished using vascularized free fibula flaps (FFF). But not all patients are candidates for FFF. A two-staged protocol (SPR) was developed taking into account the challenges of the surgical site and comorbidities of the patient utilizing custom prosthetics. Methods: This study retrospectively analyzed 16 patients (13 males, 3 females) who developed stage III ORNJ subsequent to radiation and molar extraction (FFF n=4, SPR n=12). Postoperative surgical complications, maximal incisal opening (MIO), Pain Visual Analog Scale (VAS) at the different end points for the SPR and FFF group were analyzed. Results: All patients demonstrated decrease in pain and increased mouth opening. Comparing Stage 1 SPR and FFF patients, there was a significant difference in pain, but not in function (1.89 ± 1.05 vs 0.25 ± 0.5, p<0.01 and 28.44 ± 8.10 vs 24.75 ± 1.26 p>0.20). After completion of the second stage surgery, there were significant differences in function, but not in pain in comparison to FFF patients (24.75 ± 1.26 vs 36.5 ± 8.37, p<0.026 and 0.25 ± 0.5 vs 0.17 ± 0.41, p>0.779). Conclusion: Reconstruction of the temporomandibular joint with a custom prosthesis contributes to the significant improvement in function in the stage 1 SPR and in pain in stage 2 SPR versus the FFF.