Abstract
Once medication-related osteonecrosis of the jaw (MRONJ) develops, patients suffer from pain and severe functional disor der. Furthermore, it is difficult to treat an extensive lesion in MRONJ. In this study, we report a MRONJ patient in whom mandibulectomy, mandibular reconstruction with free fibular flap, and occlusal reconstruction with a dental implant were ef fectively performed.
The patient was a 73-year-old female. She consulted a private dental clinic with left lower molar pain in March 2011. Under a diagnosis of periodontitis of the left lower first premolar, tooth extraction was performed. She felt pain in the left lower mo lar region, and consulted a private dental clinic. Hemorrhage and pus discharge were observed around the tooth extraction socket. She visited our department for examination and treatment in October 2011. Her medical history was right mastecto my for right breast cancer with lymph node dissection. Chemotherapy with docetaxel hydrate (Taxotere®), zoledronic acid hydrate (Zometa®), and medication with capecitabine (Xeloda®) was performed by intravenous administration. Therefore, under a diagnosis of MRONJ, conservative treatment including oral health care, irrigation of the lesion, and antimicrobial therapy were started from the time of the initial consultation in our department. In addition, hyperbaric oxygen therapy was performed. However, the symptoms worsened and the area of osteonecrosis rapidly expanded.
Therefore, it was considered difficult to continue conservative therapy and surgery was planned. In July 2012, segmental resection of the mandible and reconstruction with revascularized fibular free flap were performed. There was no recurrence of MRONJ during the postoperative course. In May 2013, dental implants were secondarily planted. Subsequently, vestibular plasty was performed with secondary surgery. In December 2014, a removable denture was set, resulting in high satisfaction of the patient. In the present case, we selected surgery for MRONJ, and suggest the usefulness of occlusal reconstruction with dental implants.
