Abstract
The patient was a 68-year-old woman. One year prior, she had undergone dental treatment of her right mandible at a dental clinic and had developed mandibular bone exposure. Her medical history included treatment with Zometa (zoledronic acid, bisphosphonate) infusion for bone metastasis from right breast cancer, resulting in a diagnosis of bisphosphonate-related osteonecrosis of the jaw. At the Department of Oral and Maxillofacial Surgery in our hospital, conservative treatment was performed by removing the separated necrotic bone. However, osteomyelitis progressed to stage 3 with the formation of a submandibular fistula. At 72 years of age, segmental mandibulectomy was performed, followed by mandibular reconstruction using a vascularized fibula flap. One month postoperatively, pus discharge was observed in the mental region. Magnetic resonance imaging and bone scintigraphy suggested osteomyelitis in the remaining left mandible and the central part of the transplanted fibula. After continuous irrigation through the fistula, fistula closure was performed by removing the titanium plate. At 75 years of age, the dental implants were placed in the transplanted fibula. The entire process, from onset to fixation of the dental prosthesis took nine years. Considering the current recommendations for aggressive and extensive surgery, segmental mandibulectomy with mandibular reconstruction should be considered earlier.
Postoperative fi ndings at four years after surgery (age: 76 years).
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(a) Panoramic radiography and intraoral fi ndings after implant surgery. (b) Panoramic radiography and intraoral fi ndings after placing abutment. (c) Reconstructed occlusion. (d) Mouth opening. (e) Right view. (f) Donor right leg. No contracture at the fi rst toe.
