Multiple myeloma: The case for ORIF and inferior alveolar nerve grafting

Abstract

Multiple myeloma is a plasma cell malignancy occurring most commonly in the fifth decades of life. Often skeletal lesions precipitate back pain, which lead to identification to osteolytic lesions in the spine. While mandibular involvement in multiple myeloma has been reported in the past, it is an uncommon and historically has been managed with radiation and chemotherapy. In this case report, we explore a unique presentation of multiple myeloma that resulted in both pathologic fracture and effacement of the left inferior alveolar nerve. Rather than manage the long-term complications of MRONJ and osteoradionecrosis, surgery was elected as the initial therapy, followed by medical management. The fracture was treated with open reduction and internal fixation by reconstruction plate. The nerve was reconstructed with a cadaveric nerve graft. Both procedures were completed intraorally during a single surgical intervention. The site healed without complication and patient experienced compete recovery of form, function, and sensation. Currently, the patient is undergoing medical therapy and tolerating it well.