Fibula free flap with endosseous implants for reconstructing a resected mandible in bisphosphonate osteonecrosis.
OBJECTIVE
Bisphosphonates are a class of drugs with several uses. Primarily, they are used to treat bone metastases, multiple myeloma, Paget's disease, and osteoporosis. However, the use of bisphosphonates can lead to osteonecrosis of the jaws. Here, we present our experience treating this widely discussed disease.


METHODS
We describe a patient who underwent surgical reconstruction of the mandible with a fibula free flap after total mandibulectomy, performed to treat osteonecrosis induced by the use of intravenous bisphosphonates complicated by a mandibular fracture. Endosseous implants were inserted simultaneously to optimize the length and outcome of surgery.


RESULTS
Osteonecrosis of the jaws is a treatment challenge, and several approaches have been suggested. In this patient, the use of a fibula free flap to reconstruct the mandible was a winning strategy. The patient is now free from disease, and the esthetic results were optimal.


CONCLUSIONS
With the simultaneous placement of endosseous dental implants, the functional outcome was optimal, with no significant complications or recurrence.
Ferrari
Silvano
S
Department of Maxillo-Facial Surgery, Division of Head and Neck, University of Parma, Parma, Italy.
Bianchi
Bernardo
B
Savi
Andrea
A
Poli
Tito
T
Multinu
Alessandra
A
Balestreri
Alfredo
A
Ferri
Andrea
A
D000368:Aged; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D016025:Bone Transplantation / Q000379:methods; D003758:Dental Implantation, Endosseous; D004164:Diphosphonates / Q000009:adverse effects*; D005360:Fibula / Q000637:transplantation; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery; D008336:Mandibular Diseases / Q000139:chemically induced / Q000150:complications / Q000601:surgery*; D008337:Mandibular Fractures / Q000150:complications; D013516:Oral Surgical Procedures, Preprosthetic / Q000379:methods*; D010020:Osteonecrosis / Q000139:chemically induced / Q000150:complications / Q000601:surgery*; D000077268:Pamidronate; D019651:Plastic Surgery Procedures / Q000379:methods; D013524:Surgical Flaps
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D000077268:Pamidronate