MORGANTOWN, W.Va. – Tanya Fancy, M.D., Jeffson Chung, M.D., and William Stokes, M.D., head and neck surgeons with WVU Medicine Otolaryngology and the WVU Cancer Institute, performed WVU Medicine’s first jaw reconstruction using a bone-containing thigh free flap to treat a patient with an aggressive form of oral cancer.
“For more advanced cancers, surgery to remove the cancer is required in addition to surgery to reconstruct the defect created by the cancer,” Dr. Fancy said. “We usually do this as a two-team approach, with one surgeon doing the cancer resection and the other harvesting the tissue for the reconstruction.”
In this case, Dr. Chung determined that an osteocutaneous anterolateral thigh free flap would be needed. This free flap procedure harvests skin, muscle, and bone for the reconstruction and offers several benefits, such as greater tissue volume for very large defects, bone for jaw reconstruction, and the donor site can be closed without a skin graft, which would usually be needed for the more traditional fibular free flap.
This marked the first time the procedure has been performed at WVU Medicine.
“This will likely not be a common procedure, as we usually do have alternatives for jaw reconstruction,” Chung said. “However, this is a great tool to have for challenging reconstruction cases. I am sure we will be called upon to use this again in the future.”
Joey Jaynes, a Franklin resident, had been experiencing pain in his tongue and swelling on the right side of his neck, which was initially thought to be a salivary gland infection. However, when a suspicious growth was discovered in his mouth, he was referred to the WVU Cancer Institute for evaluation.
During his first appointment, two things were clear to Fancy. First, Jaynes did, in fact, have cancer; he was diagnosed with squamous cell carcinoma of the oral cavity. And second, his treatment plan would include surgery.
“His initial prognosis was fair given the fact there was no evidence of spread to any distant sites in the body,” Fancy explained. “However, at the time that I saw him, we found that he had a second cancer in his larynx (voice box) that we discovered on a scope exam and was also seen on his PET scan, which would require treatment.”
Ultimately, Jaynes and the care team decided to move forward with surgery for both the oral cavity and larynx cancers followed by radiation and chemotherapy.
A fibular free flap was first considered but was ruled out when a diagnostic imaging test showed Jaynes had significant vascular disease in his lower legs.
“We were aware that he already had hardware in his right femur from a previous trauma, so Dr. Chung suggested using skin, muscle, and bone from the femur as an option,” Fancy said. “Since the femur was already stabilized with hardware from his prior trauma, we would not have to worry about our bone harvest weakening his femur.”
“A conventional anterolateral thigh free flap would usually not include the bone, which is what makes this case special,” Chung added.
Since the successful completion of the surgery, Jaynes is onto the next phase of his treatment plan: radiation and chemotherapy. He still has a feeding tube and has yet to start using his speaking valve, but expressed his gratitude with assistance from his son-in-law, Olen Ice.
“The treatment is great. Communication has been thorough and clear. I appreciate that the most,” he said. “These doctors have been really good.”