Timing of Reconstruction

In the past, most mandibular reconstructions were delayed because of the inability to transfer tissue immediately. A rationalization for this approach included the idea that sufficient time should be allowed to get through the period for highest risk of local recurrence. This is now considered purely an excuse for inadequate reconstructive techniques. The idea that one should wait to see if the cancer recurs prior to performing the reconstruction is also invalid since contemporary techniques of accurate radiologic assessment and frozen-section controls at the time of surgery ensure adequate resection. These methods, coupled with adjuvant radiotherapy, have reduced the risk of local recurrence to an irreducible minimum.

It is essential to reconstruct the segmental mandibular defect immediately because if the resected ends of the mandible are allowed to scar and fibrose, one can never restore the native mandible to its proper position. Postoperative radiation therapy compounds the problem with contracture, and creates a functional trismus that can never be corrected. The refinement of microsurgical techniques has allowed the reconstructive surgeon to immediately and reliably transfer well-vascularized bone and soft tissue in a single operation. Immediate replacement of the tissue that is lost contributes significantly to primary wound healing. This decreases hospital stay and also helps the patient's psychological status by restoring their sense of well-being and body image. The ability to initiate radiotherapy/chemotherapy early after surgery is a further benefit of primary reconstruction. Thus immediate reconstruction generally provides the optimal esthetic and functional result and is indicated for most patients.

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