Mandibular reconstruction in elderly patients.

BACKGROUND AND OBJECTIVES: The choice of reconstructive technique for a segmental mandibular defect in elderly patients is controversial. The aim of this study was to establish an algorithm for selecting a method of mandibular reconstruction in elderly patients.

METHODS: We retrospectively evaluated 121 patients aged ≥65 years who underwent immediate microvascular mandibular reconstruction after oncologic resection. Patients were divided into three groups based on method of reconstruction: vascularized bone graft (n = 49), mandibular reconstruction plate and soft tissue flap (n = 22), and soft-tissue flap (n = 50). We compared perioperative outcomes among groups and investigated factors affecting the choice of reconstructive technique.

RESULTS: Rates of postoperative complications did not differ significantly among groups. Mandibular reconstruction plate was indicated only for anterior mandibular defects. Soft-tissue flap was indicated for posterior mandibular defects in patients aged ≥75 years or with a poor postoperative Eichner index.

CONCLUSIONS: Mandibular reconstruction plate and soft-tissue flap can be good alternatives to vascularized bone graft in the elderly. Our algorithm uses defect type, patient age, and postoperative Eichner index to determine reconstructive technique.