ARRS 2022 Abstracts

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E1109. Mandibular Reconstruction: What the Radiologist Needs to Know
Authors
  1. Erik Soule; The University of Florida College of Medicine – Jacksonville
  2. Sanjay Lamsal; The University of Florida College of Medicine – Jacksonville
  3. Ashleigh Weyh; The University of Florida College of Medicine – Jacksonville
  4. Peter Fiester; The University of Florida College of Medicine – Jacksonville
  5. Jeet Patel; The University of Florida College of Medicine – Jacksonville
  6. Matthew Jenson; The University of Florida College of Medicine – Jacksonville
  7. Dinesh Rao; The University of Florida College of Medicine – Jacksonville
Background
Mandibular reconstruction most commonly occurs in the setting of squamous cell carcinoma of the oral cavity. Other indications for mandibular reconstruction include trauma, necrosis from radiotherapy and medication, and rarely, dental infection. The source of autologous bony free-tissue transfer for mandibular reconstruction include the fibula, iliac crest, scapula, and the radius. Surgeons have proposed a “trilaminar” concept (mucosa, bone, skin) to replace resected tissue with “like tissue.” Goals of reconstruction are to return patients to a pre-disease state by restoring: normal contours of the lower 1/3 of the face; chewing; phonation; breathing; and dental rehabilitation (dental implants).

Educational Goals / Teaching Points
The goals of this exhibit are to review the indications for mandibular reconstruction; review the surgical options and decision making involved in presurgical planning; review the advantages and disadvantages of different types of autologous flap options; review options for mandibular condylar reconstruction; and emphasize relevant imaging findings prior to and after mandibular flap reconstruction.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Microvascular free flaps are harvested to include an artery and vein, which then requires microsurgical anastomosis most commonly to major vessels of the neck in close proximity to the defect. The fibular free flap (FFF) is the gold standard and workhorse flap for the reconstruction of mandibular defects. The FFF receives arterial blood supply from the peroneal artery and periosteal branches. Doppler ultrasound, CT, and MR angiography can be performed to assess for patent three-vessel flow to the lower extremity. The ipsilateral facial artery and vein are most commonly used when reconstructing the mandible. The superior thyroid artery, external jugular vein, and internal jugular vein, as well as contralateral neck vessels, can be used as recipient vessels. In patients who have undergone previous neck dissections or radiation therapy, accurate evaluation of the head and neck vasculature is critical to ascertain the presence or absence of the above named vessels.

Conclusion
Microvascular surgical techniques have evolved over the past 20 years utilizing autologous free tissue transfer, allowing for reconstruction of mandibular and oral cavity defects involving bone, mucosa, skin and connective tissue. Knowledge of reconstruction methods is necessary for pre and post-operative image interpretation.