Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, 89081 Ulm, Germany.
Department of Oral and Maxillofacial Surgery, University Hospital Ulm, 89081 Ulm, Germany.
Medicina (Kaunas). 2023 Mar 9;59(3):535. doi: 10.3390/medicina59030535.
Medication-related osteonecrosis of the jaw (MRONJ) has been an integral part of the maxillofacial patient population for some time. The therapeutic concept ranges from conservative approaches over less extended decortications to major jaw resections, which can result in a considerable loss of quality of life. Based on three case reports, this paper presents the long-term history of patients with MRONJ of the mandible, whose disease ultimately resulted in partial or total mandibular resection and subsequent multisegmental reconstruction using a microvascular anastomosed bone flap. Furthermore, a suitable alternative for complex mandibular reconstruction is demonstrated when using a free fibula flap is not possible. The options are limited, particularly when multisegmental restoration of mandibular continuity is required. One case presents a mandible reconstruction using a CAD/CAM-guided bilateral scapular free flap (CAD/CAM = Computer-Aided Design and Manufacturing), which has not been described for this purpose before. Due to the complexity, computer-assisted surgery and patient-specific implants seem reasonable, which is why a special focus was applied to this topic.
药物相关性下颌骨坏死（MRONJ）在一段时间以来一直是颌面患者群体的一个组成部分。治疗方案的范围从保守方法到较少扩展的去皮质化，再到主要的颌骨切除术，这可能导致生活质量的显著下降。基于三个病例报告，本文介绍了下颌骨 MRONJ 患者的长期病史，他们的疾病最终导致部分或全部下颌骨切除术以及随后使用微血管吻合骨瓣进行多节段重建。此外，当无法使用游离腓骨瓣进行复杂的下颌骨重建时，本文展示了一种合适的替代方案。当需要多节段恢复下颌骨连续性时，选择是有限的。有一个病例采用 CAD/CAM 引导的双侧肩胛骨游离皮瓣（CAD/CAM = 计算机辅助设计和制造）进行下颌骨重建，这在以前的文献中并未有过描述。由于复杂性，计算机辅助手术和患者特异性植入物似乎是合理的，这就是为什么本文特别关注这个主题的原因。
