Mandibulectomy and free flap reconstruction for bisphosphonate-related osteonecrosis of the jaws.
OBJECTIVE
Bisphosphonate-related osteonecrosis of the jaws is an increasingly recognized complication of intravenous and oral bisphosphonate therapy. Our experience suggests that mandibulectomy and free flap reconstruction is an effective treatment for patients with stage 3 and recalcitrant stage 2 disease.


OBJECTIVE
To analyze indications for segmental mandibulectomy and microvascular free flap reconstruction for bisphosphonate-related osteonecrosis of the jaws and surgical outcomes following this procedure.


METHODS
In a multi-institutional case series study conducted in academic tertiary care centers, 13 patients underwent segmental mandibulectomy and microvascular free flap reconstruction, including 8 patients with stage 3 disease and 5 patients with recalcitrant stage 2 disease. All patients had persistent or progressive disease despite conservative oral care and antibiotic treatment.


METHODS
Segmental mandibulectomy and microvascular free flap reconstruction.


METHODS
Treatment efficacy and postoperative complications. RESULTS There was 1 total flap loss due to infection. The patient with a flap loss ultimately underwent a successful fibula osteocutaneous free flap reconstruction after serial irrigation and debridement. The overall complication rate was 46% (n = 6). All complications occurred in patients with stage 3 disease. Ultimately, all patients achieved a successful reconstruction, with no recurrences. All patients tolerated a soft or regular diet postoperatively.


CONCLUSIONS
Bisphosphonate-related osteonecrosis of the jaws is an increasingly recognized complication of intravenous and oral bisphosphonate therapy that can occasionally progress to involve full-thickness mandibular destruction, pathologic fracture, and fistulization, as well as chronic pain and infection. Mandibulectomy and free flap reconstruction is an effective treatment for patients with stage 3 and recalcitrant stage 2 bisphosphonate-related osteonecrosis of the jaws. High rates of chronic infection and underlying medical comorbidities may predispose to a substantial perioperative complication rate.
Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston.
Matthew M
MM
Hanasono
Oleg N
ON
Militsakh
Jeremy D
JD
Richmon
Eben L
EL
Rosenthal
Mark K
MK
Wax
D000368:Aged; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005360:Fibula / Q000637:transplantation*; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D063168:Mandibular Osteotomy / Q000379:methods*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome