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Facial Plastic and Reconstructive Surgery

(391) Postoperative Symmetry Following Mandibular Reconstruction with Fibula Free Flap

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • Sruti Tekumalla, BA

    Medical Student
    Sidney Kimmel Medical College
    Philadelphia, Pennsylvania, United States

    • Co-Author(s)

  • AK

    Ayan T. Kumar, MD

    Resident Physician
    Thomas Jefferson University
    Philadelphia, Pennsylvania, USA

  • BT

    Bhavana Thota, BS

    Sidney Kimmel Medical College, USA

  • MC

    Megha Chandna, BS

    Thomas Jefferson University Hospital, USA

  • EB

    Eric Barbarite, MD

    Thomas Jefferson Hospital Department of Otolaryngology-Head and Neck Surgery, USA

  • HK

    Howard Krein, MD PhD

    Assistant Professor Co-Director, Herbert Kean Center for Facial Aesthetics
    Thomas Jefferson Hospital Department of Otolaryngology-Head and Neck Surgery
    Philadephia, Pennsylvania, USA

    • Senior Author(s)

  • RH

    Ryan N. Heffelfinger, MD

    Professor, Department of Otolaryngology - Head and Neck Surgery Director, Division of Facial Plastic and Reconstructive Surgery
    Thomas Jefferson Hospital Department of Otolaryngology-Head and Neck Surgery
    Philadelphia, PA, United States

Disclosure(s):
Sruti Tekumalla, BA: No relevant relationships to disclose.


Introduction: Mandibular defects can result in significant functional and aesthetic sequelae requiring free flap reconstruction. Advantages of the fibula flap include ample bone stock, low donor site morbidity, and feasibility of dental implantation. Its postoperative aesthetic outcomes, however, have not yet been quantitatively defined. This study examines predictors of postoperative facial symmetry outcomes in patients who have undergone fibula free flap reconstruction of the mandible.

Methods: This was a retrospective review of 32 patients. Resting position postoperative photographs at a minimum of 6 months after mandibular reconstruction were obtained for facial symmetry analysis using Emotrics, an artificial intelligence software. Brow height (BH), marginal reflex distance (MR), oral commissure excursion (CE), smile angle (SA) and dental show (DS) were evaluated. Difference in means using ANOVA and two-tailed T test were significant if p< 0.05.

Results: Mean time to postoperative facial photograph assessment was 36.2 months. Location of mandible resection including angle-to-parasymphysis, body-to-condyle, and hemi-mandibulectomy were not associated with significant symmetrical outcomes. CE symmetry significantly improved with additional bone fragments and was greatest with three total fragments (p < 0.05). Age, smoking status and the presence of at least 1 medical comorbidity were not significantly associated with postoperative facial symmetry.

Conclusions: Optimization of post-operative symmetry following mandibular reconstruction using fibula free tissue transfer is largely independent of age, smoking status, comorbidities, and location of defect. The number of fibula bone fragments should be a point of consideration in preoperative planning, particularly for oral commissure aesthetic outcomes.