Fibula Free Flap for Mandibular Reconstruction using Simulation Surgery in Bisphosphonate related Osteonecrosis of the Jaw

Abstract

PurposeZZBisphophonate-related osteonecrosis of the jaw (BRONJ) is an emerging problem. Extensive osteonecrosis of the jaw needs free flap reconstruction. Free fibular flap is the most useful flap for maxilla-mandibular hard and soft tissue reconstruction. The advantages of fibular free flap are simultaneous soft and hard tissue reconstruction and placing implant in reconstructed mandible and maxilla. In this study, four consecutive BRONJ patients who underwent fibula free flap reconstruction using simulation surgery were reviewed. Materials and MethodsZZFour BRONJ patients who underwent free fibula reconstruction between May 2006 and September 2014 were included in this study. Male to female ratio was 1:3 and average age was 67.3 years old (62-70). All patients need mandibular bone reconstruction. Three patients suffered from osteoporosis and one male patient had multiple myeloma. Postoperative flap survival, functional reconstruction, esthetic results, food taking were evaluated. ResultsZZThree osseous flaps and one osteocutaneous flap were used. All the fibular flaps were survived and patients were recovered without complications. Oro-cutaneous fistula was resolved after operation. All patients were satisfied with the esthetic results. Patients reported improved solid food intake after operation with partial denture. One fully edentulous patient had semi-fluid diet after operation. ConclusionZZTreatment of the BRONJ is difficult due to lack of standard protocol. Fibular free flap using simulation surgery is the workhorse flap for mandibular hard and soft tissue reconstruction, especially in stage III BRONJ patient. In this study, functional and esthetic results were successful in all patients. Normal diet was possible with partial dentures. Key WordsZZ3D RP model ㆍSimulation surgery ㆍFibula free flap ㆍReconstruction ㆍBRONJ.

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“…Microsurgical technique could be mastered through preclinical experiments, however, time-consuming mandibulectomy and fibular bending requires more efficient way to expedite operation. One of the easiest ways to reduce intraoperative time is using simulation surgery with virtual 3-dimensional (3D) model before surgery (4)(5)(6)(7). Mock surgery using 3D rapid prototype (RP) model is helpful for mandibular reconstruction.…”

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