Unit of Otolaryngology - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy.
Unit of Maxillo-Facial Surgery and Dentistry - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy.
J Otolaryngol Head Neck Surg. 2022 Jul 28;51(1):29. doi: 10.1186/s40463-022-00579-5.
Mandibular osteonecrosis may occur in 5% of the patients who undergo radiotherapy for the treatment of head and neck malignancies. Resection and microvascular reconstruction is the treatment of choice in complicated osteoradionecrosis, however multifocal presentation may complicate the management of the disease given the poor quality and limited availability of adequate recipient vessels.
A 74-year-old man affected by multifocal severe osteoradionecrosis of the mandible underwent bilateral resection of the mandibular bodies while preserving the symphysis. The defects were reconstructed with a single fibula flap composed by two bony segments connected by a central segment, corresponding to the symphyseal region, in which the bone was dissected and removed. The anastomosis was performed on a single side of the neck. Healing was uneventful and the adopted technique allowed for a quick functional and esthetic recovery.
The presented technique provided a safe and efficacious, although technically challenging, solution in a case presenting multifocal osteonecrosis of the jaw. The morbidity of the procedure was limited because the tissue resection and reconstruction processes were minimized.
下颌骨坏死可能发生在 5%接受头颈部恶性肿瘤放射治疗的患者中。对于复杂的放射性骨坏死，切除和微血管重建是首选治疗方法，然而，多发病灶的表现可能会使疾病的治疗变得复杂，因为合适的受区血管质量差且数量有限。
一名 74 岁男性患有下颌骨多灶性严重放射性骨坏死，接受了双侧下颌体切除术，同时保留了下颌联合。通过单个由两个骨段组成的腓骨瓣进行缺损重建，两个骨段由中央段连接，中央段对应于联合区域，在此区域中，骨被解剖和去除。吻合在颈部的一侧进行。愈合顺利，所采用的技术实现了快速的功能和美观恢复。
该技术为多发性颌骨坏死的病例提供了一种安全有效的解决方案，尽管具有一定的技术挑战性。由于最大限度地减少了组织切除和重建过程，因此该手术的发病率较低。
