Mandible reconstruction in bisphosphonate relatednecrosis

Aims: to point out the feasibility of microsurgical reconstructionof the mandible in patients with bisphosphonate-relatedosteonecrosis (BRONJ).Methods: seven patients with extensive mandibular osteonecrosisunderwent subtotal mandibulectomy and immediate reconstructionwith a free fibula flap. They were six women and one managed 49 to 72 years. The mean size of the bone and oral mucosadefects were 18.5 cm and 22.5 cm2 respectively.Results: the mean time of surgical intervention was 12 hours.All flaps survived and the post-operative course was uneventful.Oral feeding was resumed 14 days after surgery in all cases. Thedonor legs healed without complications. The pathology reportconfirmed the diagnosis of BRONJ in all patients. Normal bonewas detected at the resection margins in six out of seven patients.Patients were followed-up at intervals of three months. After amedian follow-up time of 23 months, no clinical and radiographicevidence of recurrent BRONJ were detected in six patients. Onepatient with osteomyelitis at the resection margins had signs ofrecurrent BRONJ six months after surgery. The overall curativerate of the population was 86%.Conclusions: Despite the limited number of patients studied sofar, our data show that mandible reconstruction with the fibulaflap is feasible and does not influence the natural course of theprimary disease in BRONJ-resected patients.