title: Hemimandibulectomy and vascularized fibula flap in bisphosphonate-induced mandibular osteonecrosis with polycythaemia rubra vera.
abstract: This report presents the successful management of an advanced and refractory bisphosphonate-related osteonecrosis of the jaws (BRONJ) by hemimandibulectomy and an osteocutaneous fibula flap reconstruction in a patient with polycythaemia rubra vera, a rare haematological condition in which there is increased risk of thrombosis and haemorrhage. Union of the vascularized bone with the mandible depends on obtaining a BRONJ-free margin and rigid fixation of the bony ends. Magnetic resonance imaging can provide accurate delineation of necrotic bone and area of osteomyelitis. Placement of a 1cm margin beyond this can envisage a BRONJ-free margin. Aggressive medical management of polycythaemia rubra vera by venesection, asprin and cytoreduction therapy along with anticoagulant prophylaxis against thromboembolic events in the first 2 weeks following major surgery can provide the basis of a good surgical and flap outcome. Nevertheless, the possibility of unpredictable haemorrhage must be considered throughout.
authors.affiliation: Maxillofacial Unit, Queen Victoria Hospital, East Grinstead, United Kingdom. naseemghazali@doctors.org.uk
authors.forename: N
authors.initials: N
authors.lastname: Ghazali
authors.forename: J C
authors.initials: JC
authors.lastname: Collyer
authors.forename: J V
authors.initials: JV
authors.lastname: Tighe
mesh_terms: D000369:Aged, 80 and over; D019386:Alendronate / Q000009:adverse effects; D001241:Aspirin / Q000627:therapeutic use; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000150:complications / Q000601:surgery*; D050071:Bone Density Conservation Agents / Q000009:adverse effects; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005598:Fractures, Spontaneous / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008336:Mandibular Diseases / Q000601:surgery*; D008337:Mandibular Fractures / Q000601:surgery; D063168:Mandibular Osteotomy / Q000379:methods*; D018962:Phlebotomy; D011087:Polycythemia Vera / Q000150:complications* / Q000628:therapy; D011183:Postoperative Complications / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000379:methods; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps / Q000637:transplantation*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
chemical_list: D050071:Bone Density Conservation Agents; D005343:Fibrinolytic Agents; D001241:Aspirin; D019386:Alendronate