Novel surgery rebuilds osteosarcoma patient's mandible

A new surgical technique can rebuild a functional lower mandible and mouth while preserving a patient's ability to eat and speak after removing an invasive facial tumor, according to researchers from the Henry Ford Hospital.

Their study, which will be presented this week at the American Academy of Facial Plastic and Reconstructive Surgery meeting in Washington, DC, documented a rare occurrence of osteosarcoma spreading from a patient's right femur to his mandible.

The case involved a 21-year-old African-American man with a history of osteosarcoma. The condition affects 5 million patients younger than age 20 and about 500 adults, ages 15-30, each year in the U.S. The patient in this case had a tumor that involved nearly all of his mandible, lower lip, chin, neck skin, tongue, and both cheeks -- approximately the lower third of the face and upper half of his neck, the hospital noted in a press release.

The patient's osteosarcoma spread to his mandible a few years after the initial diagnosis. The facial tumor soon grew to nearly 10 lb of tissue and bone, making it difficult for him to speak and eat. The patient required a feeding tube.

Prior to coming to Henry Ford, the patient underwent multiple treatments, including mandible resection, radiation, chemotherapy, and cryosurgery at another institution. All treatments were unsuccessful.

Tamer Ghanem, MD, PhD, director of the Head and Neck Oncology & Microvascular Surgery Division at Henry Ford Hospital, devised a plan that would surgically remove the tumor and also rebuild the lower third of the patient's face during a single 20-hour surgical procedure.

He and his colleagues performed a near total mandibulectomy and removal of the tongue, mucous membrane from the inside of both cheeks, and lower lip. Dr. Ghanem performed the complex reconstruction using dual microvascular free flaps from the fibula and shoulder areas.

Only three months after the surgery, the patient was able to talk and eat without assistance.

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