Presented at the Triological Society Meeting at Combined Otolaryngology Spring Meetings, Las Vegas, Nevada, U.S.A., April 28–May 2, 2010.
Facial Plastics/Reconstructive Surgery
Article first published online: 7 SEP 2010
Copyright © 2010 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 120, Issue 11, pages 2165–2171, November 2010
How to Cite
Seth, R., Futran, N. D., Alam, D. S. and Knott, P. D. (2010), Outcomes of vascularized bone graft reconstruction of the mandible in bisphosphonate-related osteonecrosis of the jaws. The Laryngoscope, 120: 2165–2171. doi: 10.1002/lary.21062
The authors have no funding, financial relationships, or conflicts of interest to disclose.
- Issue published online: 22 OCT 2010
- Article first published online: 7 SEP 2010
- Manuscript Accepted: 11 MAY 2010
- Bisphosphonate-related osteonecrosis of the jaws;
- free flap reconstruction;
- vascularized bone graft;
- mandible osteonecrosis;
- Level of Evidence: 4.
To describe the clinical entity and therapeutic challenges of bisphosphonate-related osteonecrosis of the jaws (BRONJ). The use of vascularized bone grafts for reconstruction of the mandible in extensive BRONJ is proposed.
Multi-institutional retrospective review.
Patients undergoing mandible reconstruction with vascularized bone grafts after segmental mandible resection for BRONJ were evaluated. Mandible reconstruction was only performed on patients with intractable pain, fistulae, or pathologic fracture and after failure of comprehensive conservative therapy. No patients had a history of primary or metastatic head and neck malignancy or radiation therapy. Bone union was established with follow-up radiography.
Eleven patients met inclusion criteria. Mean patient age was 61.3 years. Median follow-up was 13.9 months. All patients had undergone therapy with bisphosphonates and had no other identifiable cause of mandible osteonecrosis. Preoperatively, pathologic mandible fractures were present in 73% of patients, and 36% had orocutaneous fistulae. Fibula osteocutaneous flaps were used in all cases with no failures. In all patients, bony union was demonstrated clinically and radiographically. Postoperative wound complications occurred in 36% of patients but were all treated successfully with conservative therapy. There was no BRONJ recurrence within the study follow-up period.
Osteonecrosis is a significant complication of bisphosphonate therapy, and current literature does not support vascularized reconstruction. We demonstrate that vascularized bone graft reconstruction with the fibula free flap offers a high success rate of bony union and fistula closure and should be offered to selected patients with advanced cases of BRONJ. Laryngoscope, 2010