Refinements in the reconstruction of bisphosphonate-related osteonecrosis of the jaw
Taku Maeda,
Yuhei Yamamoto,
Akira Satoh,
Toshihiko Hayashi
Affiliations
Taku Maeda
Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo City, Hokkaido 060-8638, Japan
Yuhei Yamamoto
Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo City, Hokkaido 060-8638, Japan
Akira Satoh
Department of Oral Diagnosis and Medicine, Graduate School of Dental Medicine, Hokkaido University, Kita 13, Nishi 7, Kita-ku, Sapporo City, Hokkaido 060-8586, Japan
Toshihiko Hayashi
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Asahikawa Medical University, 2-1-1-1, Midorigaoka higashi, Asahikawa City, Hokkaido 078-8510, Japan; Corresponding author at: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Asahikawa Medical University, 2-1-1-1, Midorigaoka higashi, Asahikawa City, Hokkaido 078-8510, Japan.
The recommended treatment strategy for stage 3 bisphosphonate-related osteonecrosis of the jaw (BRONJ) is currently rigid plate fixation without bone reconstruction. However, a recent systematic review indicated the utility of microsurgical reconstruction after resection of BRONJ. Several types of flaps have been described but their applications are controversial. Here we present a detailed reconstruction plan for obtaining better outcomes in patients with maxillary and mandibular BRONJ. Given that progressive maxillary BRONJ is often invasive to the skin, including the eyelid, leading to functional loss such as leakage of discharge and ectropion, several revision surgeries are needed to increase the volume in the defect after the free flap transfer. For progressive mandibular BRONJ, hemi-mandibulectomy to subtotal mandibulectomy with an adequate margin from the necrotic bone is necessary, followed by a well-designed fibular free flap.
