Skip to main content

ORIGINAL RESEARCH article

Front. Oncol.
Sec. Head and Neck Cancer
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1527149
This article is part of the Research Topic Multidisciplinary Management of Oral Cancer: Diagnosis, Treatment, and Rehabilitation View all articles

Osteoradionecrosis In Osseous Free Flaps After Maxillofacial Reconstruction: A Single-Center Experience

Provisionally accepted
Jakob Fenske Jakob Fenske 1*Philipp Lampert Philipp Lampert 1Eirini Nikolaidou Eirini Nikolaidou 2Claudius Steffen Claudius Steffen 1Marcus Beck Marcus Beck 2Norbert Neckel Norbert Neckel 1Susanne Nahles Susanne Nahles 1Max Heiland Max Heiland 1Friedrich Mrosk Friedrich Mrosk 1Steffen Koerdt Steffen Koerdt 1Carsten Rendenbach Carsten Rendenbach 1
  • 1 Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Berlin, Germany, Berlin, Germany
  • 2 Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Department of Radiation Oncology, Berlin, Germany, Berlin, Germany

The final, formatted version of the article will be published soon.

    Objective: In the multimodal treatment of advanced head and neck malignancies, primary free flap reconstruction in a one stage procedure with tumor resection is frequently combined with adjuvant radiotherapy. Radiotherapy is known to exhibit side effects on transplanted free flaps, including osteoradionecrosis (ORN) of native and transplanted bone. This study aims to evaluate the therapeutic outcomes and potential predictors of free flap ORN within osseous free flaps based on a large-scale, single-center database.Methods: A retrospective analysis was conducted on patients who underwent osseous free flap reconstruction of maxilla or mandible in a one stage procedure followed by adjuvant radiotherapy due to an advanced head and neck malignancy between April 2017 and July 2023. After case matching, patients with and without free flap ORN were assessed for potential predictors using univariate and multivariate analysis.Results: 112 patients met the inclusion criteria. 21 patients (19%) developed ORN within the free flap. Following case matching, 42 patients (10 females, mean age 61.5 ± 9.1 years) were included in the final analysis. The mean time to ORN diagnosis was 19 (7-56) months after surgery. Total flap loss occurred in 7 patients (33%) following flap ORN. Smoking (76% vs. 38%; OR 5.78; p=0.03) and prior plate exposure (67% vs. 24%; OR 5.61; p=0.03) emerged as robust predictors of flap ORN in uni-and multivariate analysis.Osseous free flap ORN is a severe radiooncologic complication, often resulting in total flap loss and subsequently increased morbidity. Smoking and prior plate exposure were identified as key predictors of flap ORN development. Individual risk assessment and careful evaluation of osseous free flap irradiation must be evaluated in future radiooncological concepts.

    Keywords: Mandibular reconstruction, osseous free flaps, Osteoradionecrosis, adjuvant radiotherapy, Fibula free flap, free flap complications, flap osteoradionecrosis

    Received: 12 Nov 2024; Accepted: 14 Jan 2025.

    Copyright: © 2025 Fenske, Lampert, Nikolaidou, Steffen, Beck, Neckel, Nahles, Heiland, Mrosk, Koerdt and Rendenbach. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Jakob Fenske, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Berlin, Germany, Berlin, Germany

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.