Ko Jae Hee, Kim Min-Gyeong, Kim Sung Min, Kong Ui Hyun, Park Sang Hyun, Kwack Da Woon, Park Joo-Yong, Lee Jong-Ho, Choi Sung Weon
Oral Oncology Clinic, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea.
J Korean Assoc Oral Maxillofac Surg. 2024 Dec 31;50(6):356-360. doi: 10.5125/jkaoms.2024.50.6.356.
Pedicle ossification is a rare but significant complication following mandibular reconstruction using a fibular free flap (FFF), a technique widely employed in maxillofacial surgery due to its reliable vascularized bone supply and low donor site morbidity. The FFF supports dental implantation and prosthetic rehabilitation, with its vascularized periosteum enhancing osteogenic potential. Despite these advantages, unexpected ossification of the flap's vascular pedicle may occur, potentially mimicking tumor recurrence and causing diagnostic uncertainty. This case report describes a 38-year-old male with left buccal squamous cell carcinoma treated by wide excision, modified radical neck dissection, and reconstruction using a radial forearm free flap. Postoperative radiotherapy led to complications including trismus and alveolar bone exposure, culminating in a pathological mandibular fracture. Mandibular reconstruction was performed using an FFF. Over 4 years of follow-up, computed tomography revealed ossification within the vascular pedicle. Notably, the patient remained asymptomatic, maintaining normal speech and swallowing without functional impairment. Pedicle ossification may present radiographically as a suspicious bony change misinterpreted as tumor recurrence. Routine follow-up imaging such as computed tomography is essential for differentiation. Although trismus, bony swelling, or pain may occur, surgical intervention is typically deferred unless symptoms develop. Therefore, careful clinical assessment and monitoring remain crucial.
蒂部骨化是使用游离腓骨瓣（FFF）进行下颌骨重建术后一种罕见但严重的并发症，由于其可靠的带血管骨供应和较低的供区发病率，该技术在颌面外科中被广泛应用。FFF支持牙种植和修复重建，其带血管的骨膜可增强成骨潜力。尽管有这些优点，但瓣的血管蒂可能会意外发生骨化，这可能会模拟肿瘤复发并导致诊断不确定性。本病例报告描述了一名38岁男性，患有左颊鳞状细胞癌，接受了广泛切除、改良根治性颈清扫术，并使用游离桡骨瓣进行重建。术后放疗导致了包括牙关紧闭和牙槽骨暴露等并发症，最终导致病理性下颌骨骨折。使用FFF进行了下颌骨重建。在超过4年的随访中，计算机断层扫描显示血管蒂内有骨化。值得注意的是，患者仍无症状，保持正常的言语和吞咽功能，无功能障碍。蒂部骨化在影像学上可能表现为可疑的骨质改变，被误解为肿瘤复发。常规的随访影像学检查，如计算机断层扫描，对于鉴别诊断至关重要。虽然可能会出现牙关紧闭、骨质肿胀或疼痛，但通常在症状出现之前不进行手术干预。因此，仔细的临床评估和监测仍然至关重要。
