Segmental mandibulectomy and fibula free flap reconstruction for advanced mandibular osteoradionecrosis : Based on analysis of 12 cases

Eunju Kim*, Eunkyo Seo, DoHyun Kwon, Byung hoo Park, Nagwon Jang, Jaemyumg Ahn, Jun-Young Paeng

Sungkyungkwan University, Samsung Medical Center Seoul, Korea

 

Background/Objective

Osteoradionecrosis (ORN) of the mandible can result in serious complications, including exposed necrotic bone, oro-cutaneous fistula formation, soft-tissue defects, and pathologic fractures. In advanced cases requiring mandibular reconstruction, the fibula free flap (FFF) is a widely used option. We have recently achieved successful reconstruction of mandibular defects caused by ORN using an FFF. This report presents the FFF as a recommended reconstructive approach for severe mandibular ORN and describes our strategy for managing postoperative infections.

 

Methods

This retrospective study included 12 patients with ORN who were treated fibular free flap reconstruction and followed up at the Department of Oral and Maxillofacial Surgery, Samsung Medical Center, between 2023 and 2026. Clinical records and radiographic findings, including panoramic radiographs and computed tomography scans, were reviewed to evaluate ORN-related risk factors, fracture sites, treatment modalities, and the timing of diagnosis.

 

Result

All twelve patients recovered after reconstruction of the defects using FFF. The surgical sites healed uneventfully and remained stable, with favorable wound healing and no additional complications.

 

Conclusion

The fibula free flap (FFF) is a well-established reconstructive option that provides sufficient bone and soft tissue for extensive mandibular defects, particularly in patients with osteoradionecrosis (ORN). When postoperative infection develops, antibiotic therapy should be adjusted in collaboration with infectious disease specialists. Accordingly, FFF remains a reliable and recommended technique for complex mandibular reconstruction.

Optimize maxillomandibular advancement for OSA patients

Yu-Feng CHEN

 

Obstructive sleep apnea (OSA) is characterized by repetitive pharyngeal collapse, driving elevated cardiovascular morbidity, neurocognitive deficits, and drastically reduced quality of life. Continuous positive airway pressure (CPAP) remains the conventional gold standard for treatment. Unfortunately, long-term adherence to CPAP is poor, and over 60% of patients ultimately cannot tolerate it.

For patients refractory to conservative management, surgical intervention is critical. Maxillomandibular advancement (MMA), pioneered by the Stanford group in the 1980s, is currently recognized as the most effective surgical intervention for severe OSA. However, despite remarkably high overall success rates, some patients remain non-responsive or exhibit suboptimal outcomes. To maximize therapeutic success and limit treatment failure, surgical treatment must be tailored to the individual patient.

This presentation will detail a refined, evidence-based approach to MMA. My objectives include outlining the diagnostic criteria for identifying optimal MMA candidate phenotypes, demonstrating surgical technique refinements that balance airway stability with facial harmony, and reviewing long-term surgical outcomes and efficacy in the Taiwanese population.

 

Yu-Hsin CHANG

 

2002~2008 School of Dentistry at CSMU

2008~2010 Graduate Institute of Clinical Dentistry at NTU

2010~2014 Resident training at Changhua Christian Hospital

2014~2021 Attending staff at Changhua Christian Hospital

2021~now Attending staff at National Yang Ming Chiao Tung University Hospital

Endoscopic-assisted open reduction of condylar fracture

Yu-Hsin CHANG

People who encounters with mandibular fracture has a high incidence of condylar fracture (27~48%). There are several reduction and fixation methods to manage condylar fracture. Closed reduction and fixation survived as a standard protocol for more than 50 years ago. However, as development of surgical instrument and fixation devices, more and more surgeon tried to perform open reduction and internal fixation (ORIF) techniques to achieve anatomical reduction and stable fixation. Patient can recover normal occlusion function and jaw movement quickly and less temporomandibular disorder happened during further follow-up. Traditional extraoral approaches of ORIF suffer a high risk of facial nerve injury and facial scar formation. Therefore, endoscopic-assisted intraoral approaches of ORIF came out. Nowadays, the technique and procedures are easily accessible on AO surgery reference website. However, not every operation rooms have the same surgical instrument as surgery reference. We share our experience in endoscopic-assisted intraoral approach of subcondylar fracture and how to manage the unexpected problem we faced.

Tsung-Lin YANG

 

Tsung-Lin Yang   MD. PhD. EMBA

Tel: +886- 2-23123456 ext.63526 

Email: yangtl@ntu.edu.tw

Website: https://scholars.lib.ntu.edu.tw/entities/person/1e018aab-42b8-46f8-8f00-6ce435cf6850

Current positions

1. Deputy Vice President (Research and Development), National Taiwan University
2. Director, Center of Industry-Academia Collaboration, National Taiwan University
3. Director, National Taiwan University Industry Liaison Office 
4. Director, Global Industry Platform of National Taiwan University System
5. Professor, Otolaryngology and Head Neck Surgery, National Taiwan University 
6. Professor, Graduate Institute of Clinical Medicine, National Taiwan University
7. Secretary-General, Asia-Pacific Society of Thyroid Surgery (APTS)
8. President, International Head Neck Ultrasound Surgeons Association (IHNUSA)

Principal Positions Held (selected)

1. Chief, Head and Neck Surgery, National Taiwan University Hospital
2. Chairman, Otolaryngology, National Science and Technology Council
3. Chief Executive Officer, Research Center for Development Biology and Regenerative Medicine, National Taiwan University
4. Chairman, Department of Otolaryngology, National Taiwan University Hospital, Yun-lin Branch

Honors and Awards (selected):

1. Outstanding Research Award, Ministry of Science and Technology, Taiwan
2. World's Top 2% Scientists 
3. Young Investigator Award, Academia Sinica, Taiwan
4. Dr. Wu Da-You Research Award, Ministry of Science and Technology, Taiwan
5. Memorial Medical Award of Dean Chen-Yuan Lee
6. Awardee of the National Talented Youth Award, Taiwan
7. The National Innovation Award, Institute for Biotechnology and Medicine Industry, Ministry of the Interior, Taiwan. (6^th & 11^th)
8. Outstanding Research Award for Excellence in Innovation of Medical Technology, the National Taiwan University Hospital
9. Award of Best Research Paper, International Symposium of Materials on Regenerative Medicine
10. Award for extraordinary contribution, Eurosian Society of Head and Neck Oncology
11. Award of Future Tech Demo and Breakthrough
12. First case of trans-hairline robotic neck surgery in the world
13. Award of Best Research Paper of Head and Neck Oncology of Professor Tu Shih-Mian’s Academic Foundation in Otolaryngology
14. Award of Best Research Paper, Taiwan Society of Ultrasound in Medicine
15. Award of Annual Best Research Paper, Taiwan Otolaryngological Society
16. Award of Professor Tu Shih-Mian’s Academic Foundation in Otolaryngology

Bridging the Translational Gap in Cancer Therapy: A Human Three-Dimensional Cell Culture for Evaluating Biological Effects

 Kazuyo IGAWA

Institute for Emerging Medical Innovation, Okayama University

 

Recent advances in cancer therapy, particularly innovative radiation treatment modalities such as ultra-high-dose-rate (FLASH) radiotherapy, proton therapy, and boron neutron capture therapy (BNCT), offer new opportunities to improve therapeutic outcomes while minimizing damage to normal tissues. However, translating these emerging technologies into clinical practice remains challenging, partly due to the limitations of conventional preclinical models in reproducing the complexity of the human tumor microenvironment and evaluating both tumor and normal tissue responses.

We have developed a human three-dimensional (3D) head and neck cancer model incorporating human oral squamous cell carcinoma cells and patient-derived stromal fibroblasts. A key feature of this model is its ability to simultaneously evaluate radiation-induced biological effects in both cancer cells and normal stromal cells within the same 3D tissue construct. This approach enables the investigation of tumor–stroma interactions and differential radiation responses under a shared experimental environment, providing a more comprehensive assessment of therapeutic efficacy and potential normal tissue toxicity.

Using this platform, we have investigated biological responses to various radiation modalities, including X-rays, proton beams, carbon ions, and neutron irradiation. Particular emphasis has been placed on comparing conventional-dose-rate and ultra-high-dose-rate (FLASH) proton irradiation. Our findings demonstrate distinct radiation responses between conventional two-dimensional cultures and 3D tissue models, highlighting the importance of tissue architecture and stromal interactions. Furthermore, the simultaneous assessment of cancer and stromal compartments provides valuable insights into differential radiation responses, which are particularly relevant to investigating the potential therapeutic advantages of FLASH radiotherapy.

The integration of human 3D tissue models with advanced biological analyses and dosimetric approaches may further improve our understanding of radiation quality- and dose-rate-dependent biological effects. By enabling the simultaneous evaluation of tumor response and normal tissue effects, this platform offers a promising approach for preclinical assessment and optimization of emerging radiation therapies, including proton FLASH radiotherapy and BNCT.

Ultimately, human 3D cell culture technologies may help bridge the translational gap between experimental radiobiology and clinical cancer therapy, contributing to the development of safer, more effective, and personalized treatment strategies.

Hung-Ying LIN

Date of Birth	06/26/1980
E-mail	ephedrine0626@hotmail.com 019375@ntuh.gov.tw
Educational Background	1.   DDS, School of Dentistry, National Taiwan University 2.   MS. & Ph. D, Graduate Institute of Clinical Dentistry, National Taiwan University 3. Assistant Professor, School of Dentistry, National Taiwan University

Clinical Background	1.     Attending Physician and Ward Director, Department of Oral & Maxillofacial Surgery, National Taiwan University Hospital, Taipei, Taiwan 2.     Depuy Director, Simulation Center for Oral Maxillofacial Smart Medicine, NTUH  3.     Member of Association of Oral and Maxillofacial Surgeons, Taiwan 4.     Research Follow, Surgical Planning Lab, Houston Methodist Hospital, Houston, Texas
Subspecialty	1.     Orthognathic and corrective jaw surgery 2.     Endoscopic surgery in oral and maxillofacial region 3.     Virtual planning and computer-aided surgical simulation 4.     Reconstructive surgery of jaw bone

Personal Literatures

1.     Transverse and sagittal angulations of proximal segment after sagittal split and vertical ramus osteotomies and their influence on the stability of distal segment. Journal of the Formosan Medical Association (2013) 112, 244-252 2.     Epigallocatechin-3-gallate Inhibits Transforming growth factor-β1 induced Collagen Synthesis by Suppressing Early Growth Response-1 in Human Buccal Mucosal Fibroblasts. Journal of the Formosan Medical Association (2017, Feb). 3.     Three-phase treatment concept for skeletal Class III growing patients with severe space deficiency: A report of three cases with skeletally anchored maxillary protraction. Journal of the Formosan Medical Association (2020, Apr). 119, 869-878. 4.     Computer-Aid orthognathic surgery in Facial Asymmetric Patients – experiences in NTUH, 2017 21th Annual Academic Congress of Taiwan Orthodontic Society 5.     Biomimetic Synthesis of Nanocrystalline Hydroxyapatite Composites: Therapeutic Potential and Effects on Bone Regeneration. International Journal of Molecular Sciences (2019, Nov), 20(23),6002. 6.     Transcriptome analysis of gingival tissues of enamel‐renal syndrome. Journal of periodontal Research (2019, Apr), 2019,1-9 7.     Pure type-1 collagen application to third molar extraction socket reduces postoperative pain score and duration and promotes socket bone healing. Journal of the Formosan Medical Association, 118,481-487. 8.     Metastatic lung carcinoma in the right maxilla. Journal of the Formosan Medical Association(2018, Aug) 9.     Computer-Aid Orthognathic Surgery in Facial Asymmetric Patients- Experiences of NTUH. 2017 21th Annual Academic Congress of Taiwan Orthodontic Society, Taipei 10.  Endoscope assisted ORIF in mandibular condylar fracture, youth forum, 2017 30th Annual Academic Congress of Taiwanese Association of Oral and Maxillofacial Surgeons