title: Microsurgical reconstruction for radiation- and bisphosphonate-induced mandible osteonecrosis based on patient-specific physiopathologic mechanisms.
abstract: BACKGROUND
  Radiation- and bisphosphonate-induced mandible osteonecrosis have distinct underlying physiopathologic mechanisms, but both can constitute a serious problem and lead to functional impairment and facial disfigurement.
  
  
  RESULTS
  We describe different clinical situations related to several grades of osteonecrosis, where different options of free transfer should be considered based on case-specific physiopathologic mechanisms. We propose a simple clinical grading system to predict the best treatment option.
  
  
  CONCLUSIONS
  For patients with advanced refractory disease, pathologic fracture, orocutaneous fistula, and severe osteolysis, resection associated with microvascular reconstruction seems to be a valid option that stops the underlying pathophysiology of overinfected avascular bone necrosis. Physicians who understand the specific physiopathologic mechanisms of each case can incorporate them into the assessment of the required reconstruction and treatment plans.
authors.affiliation: From the Department of Plastic, Reconstructive and Maxillo-Facial Surgery, and Burn Unit, Centro Hospitalar de São João, Porto Medical School, Porto, Portugal.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Horta
authors.forename: Diana
authors.initials: D
authors.lastname: Monteiro
authors.forename: Tiago
authors.initials: T
authors.lastname: Neto
authors.forename: Rui
authors.initials: R
authors.lastname: Balhau
authors.forename: Ligia
authors.initials: L
authors.lastname: Coelho
authors.forename: Alvaro
authors.initials: A
authors.lastname: Silva
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Amarante
mesh_terms: D000328:Adult; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods; D017577:Cutaneous Fistula / Q000601:surgery; D005260:Female; D005598:Fractures, Spontaneous / Q000601:surgery; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D063168:Mandibular Osteotomy / Q000379:methods; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*