Registry to Collect Data on Patients Undergoing Segmental Mandibular Defect Reconstruction Following Oral Squamous Cell Carcinoma Resection and Drugs-induced Osteonecrosis

A Prospective, International, Multicenter Registry of Patients Undergoing Segmental Mandibular Defects Reconstruction (SMDR) After Mandibular Resection for Tumors and Drugs-induced Osteonecrosis

Prospective will be collected in a minimum of 300 patients presenting with an acquired segmental mandibular defect ≥ 2 cm secondary to OSSC removal and drugs-induced osteonecrosis, and who require mandibular reconstruction.

Study Overview

• Status: Recruiting
• Conditions: Mandibular Reconstruction; Segmental Mandibular Defects
• Intervention / Treatment: Procedure: Surgical Resection and Reconstruction

Detailed Description

Data will be prospectively collected from at least 300 patients with acquired segmental mandibular defects of 2 cm or larger following resection of tumors or necrotic/infected tissue, all of whom require mandibular reconstruction.

The follow up (FU) will consist of standard of care (routine) procedures and data collection will be done at 3, 6, 12, 18 and up to 24 months after resection and/or reconstruction. The maximum FU for each patient within the registry will be 2 years after mandibular resection.

Data collection will include confounding baseline data, tumor characteristics, neurological function, patient reported outcomes, quality of life as well as anticipated procedure-related adverse events (AEs). Available images will be collected and evaluated centrally to determine the location, positioning, osseointegration, bone quantity and quality of the transplants.

Depending on the volume and quality of the collected data, different statistical analyses will be performed. Exploratory analyses will be conducted to find relationships between the different treatment modalities and their outcomes.

• Study Type: Observational
• Enrollment (Estimated): 300

Contacts and Locations

• Study Contact: Name: Maria Medina Giner; Phone Number: 0795456120; Email: maria.medinaginer@aofoundation.org
• Study Contact Backup: Name: Marco Minoia, PhD; Email: marco.minoia@aofoundation.org

Study Locations

• Germany
  • Aachen, Germany, 52074
    • Recruiting
    • University Hospital RWTH Aachen
    • Contact: Ali Modabber, Prof; Phone Number: +49 241 80 88258; Email: Amodabber@ukaachen.de
  • Berlin, Germany, 13353
    • Recruiting
    • University Hospital Charité
    • Contact: Max Heiland, Prof; Phone Number: +49 450 655 270; Email: Max.Heiland@charite.de
  • Hanover, Germany, 30625
    • Recruiting
    • Hannover Medical School
    • Contact: Philippe Korn, PD, MD; Phone Number: +49 511 532 4879; Email: korn.philippe@mh-hannover.de
  • Heidelberg, Germany, 69120
    • Recruiting
    • Universitätsklinikum Heidelberg
    • Contact: Christian Freudlsperger, Prof; Phone Number: +49 6221 56 34444; Email: Christian.Freudlsperger@med.uni-heidelberg.de
  • Leipzig, Germany, 04103
    • Recruiting
    • University Hospital Leipzig
    • Contact: Tabea Pankow, PD, MD; Phone Number: + 49 3419721863; Email: tabea.pankow@medizin.uni-leipzig.de
  • Munich, Germany, 80337
    • Recruiting
    • Klinikum der LMU München
    • Contact: Wenko Smolka, PD, MD; Phone Number: +49 440054458; Email: Wenko.Smolka@med.lmu.de
  • Ulm, Germany, 89081
    • Recruiting
    • University Hospital Ulm
    • Contact: Marcel Ebeling; Phone Number: +49 731 1710 35806; Email: marcelebeling@uni-ulm.de
    • Principal Investigator: Marcel Ebeling
  • Baden-Wurttemberg
    • Tübingen, Baden-Wurttemberg, Germany, 72076
      • Recruiting
      • Universitätsklinikum Tübingen
      • Contact: Andreas Naros, MD; Phone Number: +49 7071 2986174; Email: andreas.naros@med.uni-tuebingen.de
• Japan
  • Izumo, Japan, 693-0001
    • Not yet recruiting
    • Shimane University
    • Contact: Takahiro Kanno; Phone Number: +81 90 5086 2506; Email: tkanno@med.shimane-u.ac.jp
    • Principal Investigator: Takahiro Kanno
• Netherlands
  • Rotterdam, Netherlands, 3015 GD
    • Recruiting
    • Erasmus University Medical Centre
    • Contact: Eppo Wolvius, Prof; Phone Number: +31 6 22 48 77 81; Email: E.Wolvius@erasmusmc.nl
• Portugal
  • Lisbon, Portugal, 1500-650
    • Not yet recruiting
    • Luz Hospital
    • Contact: Alberto Pereira; Phone Number: +351 917593318; Email: alberto.rocha.pereira@hospitaldaluz.pt
    • Principal Investigator: Alberto Pereira
    • Sub-Investigator: Henrique Messias
• Spain
  • Madrid, Spain, 28041
    • Recruiting
    • 12 de Octubre
    • Contact: Maria Mejía Nieto, MD; Phone Number: +34 687 083 530; Email: Mmejianieto@hotmail.com
• Sweden
  • Uppsala, Sweden, 75185
    • Recruiting
    • Uppsala University Hospital
    • Contact: Andreas Thor, Prof; Phone Number: +46 18 6116450; Email: Andreas.Thor@akademiska.se
• Switzerland
  • Basel, Switzerland, 4031
    • Recruiting
    • University Hospital Basel
    • Contact: Florian Thieringer, MD; Phone Number: +41 612 657 344; Email: Florian.Thieringer@usb.ch
• United States
  • Florida
    • Jacksonville, Florida, United States, 32209
      • Recruiting
      • University of Florida College of Medicine
      • Contact: Rui Fernandes, Prof; Phone Number: +1 904 244 3901; Email: Rui.Fernandes@jax.ufl.edu
  • Illinois
    • Chicago, Illinois, United States, 60612
      • Recruiting
      • University of Illinois Chicago
      • Contact: Nicolas Callahan, MD; Email: ncall@uic.edu
  • New York
    • New Hyde Park, New York, United States, 11042
      • Not yet recruiting
      • Northwell Health Cancer Institute
      • Contact: Brett Miles; Phone Number: 6462846215; Email: bmiles4@northwell.edu
      • Principal Investigator: Brett Miles
      • Sub-Investigator: Danielle Scarola
    • New York, New York, United States, 10029
      • Recruiting
      • Mount Sinai Hospital
      • Contact: Mohammed Khan, MD; Email: mohemmed.khan@mountsinai.org
  • Texas
    • Fort Worth, Texas, United States, 76104
      • Recruiting
      • John Peter Smith Health Network
      • Contact: Roderick Kim, MD; Phone Number: +1 817-702-6979; Email: roderickykim@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: N/A

• Sampling Method: Probability Sample

Study Population

Patients presenting with an acquired segmental mandibular defect secondary to oral squamous cell carcinoma removal and who require mandibular reconstruction.

Description

Inclusion Criteria:

• The study includes patients with an initial pathological/histologic diagnosis of mandibular involvement by oral tumors (such as OSCC, osteosarcoma, and ameloblastoma), bisphosphonate- or immunomodulatory drug-induced osteonecrosis, and mandibular lesions from metastatic conditions originating from other sites including lung, breast, prostate, or kidney.
• Age 18 years and older
• Bisphosphonate related osteonecrosis of the mandible
• Immunomodulatory drugs induced mandibular osteonecrosis
• Patients presented with ameloblastoma affecting the mandible
• Patients presented with osteosarcomas of the mandible
• Patients presented with oral metastases related mandibular lesions that are indicated for segmental resection, common primary tumor sites include lung, breast, prostate and kidney
• Undergoing primary curative treatment with segmental resection of the mandible ≥2 cm
• Intention to undergo mandibular reconstruction with autologous bone using a primary (one-stage) or secondary (two-stage) approach

• Informed consent obtained, ie:

  • Ability to understand the content of the patient information/ICF
  • Willingness and ability to participate in the clinical investigation according to the registry plan (RP) o Signed and dated IRB/EC approved ICF OR
  • Written consent provided according to the IRB/EC defined and approved procedures for patients who are not able to provide to provide independent written informed consent

Exclusion Criteria:

• Tumors affecting the condyle
• Patients under palliative care
• Previous extensive mandibular surgeries (including reconstructions, e.g., TMJ replacement) that may potentially confound the outcome measures

Intraoperative exclusion criteria:

• Nonsegmental mandibular defect (eg. box resection/partial resection)
• Segmental mandibular defect of less than 2 cm
• Mandibular defects extending beyond the sigmoid notch into the condyles

Additional exclusion criterion:

• No osseous reconstruction with autologous bone performed within 18 months from resection

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Mandibular Reconstruction; Patients undergoing segmental mandibular defect reconstruction. The decision of one stage or two stage reconstruction is done according to the patient and treating surgeon preferences following the local standard of care

Procedure: Surgical Resection and Reconstruction; One stage reconstruction: Osseous reconstruction is performed in the same surgery of the tumor/mandibular resection. It is also known as immediate or primary reconstruction. Second stage reconstruction: Osseous reconstruction is performed after the tumor/mandibular resection surgery as an independent surgery. After the mandibular resection a temporary alloplastic bridging might be put in place. It is also known as delayed or secondary reconstruction.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Demographics	Demographics (year of birth, height in cm and weight in kilogram, race)	Baseline until resection surgery approximately 4 weeks
Comorbidities	Comorbidities assessed by Charlson Comorbidity Index (this score assesses the comorbidity level by considering both the number and severity of predefined comorbidity conditions. It provides a weighted score of a patient's comorbidities which can be used to predict mortality rates	Baseline until resection surgery approximately 4 weeks
Nicotine consumption	Current and previous nicotine use will be collected: Number of years; Time (years) since stopped using (if applicable); Amount of cigarettes/day	Baseline until resection surgery approximately 4 weeks
Patient reported outcome: Oral Health Impact Profile (OHIP)	Change in the OHIP over the follow-up period. The Oral Health Impact Profile is providing a comprehensive measure of self-reported dysfunction, discomfort and disability attributed to oral conditions. The OHIP is concerned with impairment and three functional status dimensions (social, psychological, and physical). Respondents are asked to indicate on a five-point Likert scale how frequently they experienced each problem. Response categories for the five-point scale are: "Very often", "Fairly often", "Occasionally", "Hardly ever" and "Never". The OHIP consists of 14 questions in which higher scores indicate worse outcomes.	Baseline/ 3months/ 6 months/ 12 months/ 18 months/ 24 months
Difference of tumor locations of the oral squamous cell cancer	Oral squamous cell carcinoma locations acoording to follwoing regions: Anterior compartment which includes lower lip, buccal mucosa, anterior vestibule, anterior ridge and anterior floor mouth; Lateral compartment which includes posterior vestibule, posterior alveolar ridge, posterior (lateral) floor of mouth; Retromolar compartment which includes alveolar ridge posterior to last molar, region of wisdom teeth, retromolar triangle ie buccal cheek, soft palate (arch), tonsillar regions; Tongue which includes ventral tongue (undersurface of tongue), lateral rim of tongue, base of tongue	Baseline until resection surgery ( approximately 4 weeks)
Difference of tumor staging according to the TNM system	Oral squamous cell carcinoma staging according to TNM (Tumor, Node, Metastasis) system. In the TNM system the "T" refers to the size and extent of the main tumor likert from T0 to T4 whereas T0 is the smallest and T4 the biggest size. The main tumor is usually called the primary tumor. The "N" refers to the number of nearby lymph nodes that have cancer likert for N0 to N3 whereas N0 is the single nearby lymphnode and N3 multiple lymphnodes. The "M" refers to whether the cancer has metastasized likert from M0 to M1 whereas M0 is no distant metastasis and M1 is distant metastasis.	Baseline until resection surgery ( approximately 4 weeks)
Difference of surgical duration and hospital stay if resection and reconstruction was performed in one or two stages	Duration of surgery (skin to skin) in minutes; Length of hospital stay in days; Date of osseous reconstruction (if different from resection surgery) in days	Day of resection surgery until day of reconstruction surgery up to 18 months
Difference of surgical procedures of osseous reconstruction	Numers of Bone and soft tissue flaps to reconstruct the mandible: ie number of pieces in which the donor bone(s) is cut to shape the reconstructed mandible; Type of bone donor/ bone transfer site(s): Vascularized bone flap(s) or composite flaps (ie bone and adjacent soft tissue harvested within the same flap) and type(s)	Day of resection surgery until day of reconstruction surgery up to 18 months
Different surgical parameters of tumor and segmental mandibular resection if VSP planning was used	Use of virtual surgical planning (VSP) for resection: Yes/No.; Only virtual planning and simulation of resection (no 3D printing):Yes/No.; 3D-printed biomodels: Yes/No	Day of resection surgery until day of reconstruction surgery up to 18 months

Collaborators and Investigators

• Sponsor: AO Innovation Translation Center
• Investigators: Principal Investigator: Rüdiger Zimmerer, PD, MD, University of Leipzig

Study record dates

Study Major Dates

• Study Start (Actual): September 12, 2022
• Primary Completion (Estimated): June 30, 2030
• Study Completion (Estimated): December 31, 2030

Study Registration Dates

• First Submitted: September 13, 2019
• First Submitted That Met QC Criteria: September 18, 2019
• First Posted (Actual): September 23, 2019

Study Record Updates

• Last Update Posted (Estimated): September 4, 2025
• Last Update Submitted That Met QC Criteria: August 28, 2025
• Last Verified: August 1, 2025

More Information

Terms related to this study

• Keywords: Mandibular osteotomy; Free bone flap; Reconstructive surgical procedure; Adjuvant Irradiation / Chemotherapy
• Additional Relevant MeSH Terms: Bone Diseases; Musculoskeletal Diseases; Pathologic Processes; Necrosis; Osteonecrosis; Surgical Procedures, Operative; Plastic Surgery Procedures
• Other Study ID Numbers: SMDR Registry

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No