Fibula free flap with endosseous implants for reconstructing a resected mandible in bisphosphonate osteonecrosis

Purpose: Bisphosphonates are a class of drugs with several uses. Primarily, they are used to treat bone metastases, multiple myeloma, Paget's disease, and osteoporosis. However, the use of bisphosphonates can lead to osteonecrosis of the jaws. Here, we present our experience treating this widely discussed disease. Patient and Methods: We describe a patient who underwent surgical reconstruction of the mandible with a fibula free flap after total mandibulectomy, performed to treat osteonecrosis induced by the use of intravenous bisphosphonates complicated by a mandibular fracture. Endosseous implants were inserted simultaneously to optimize the length and outcome of surgery. Results: Osteonecrosis of the jaws is a treatment challenge, and several approaches have been suggested. in this patient, the use of a fibula free flap to reconstruct the mandible was a winning strategy. The patient is now free from disease, and the esthetic results were optimal. Conclusions: With the simultaneous placement of endosseous dental implants, the functional outcome was optimal, with no significant complications or recurrence. (c) 2008 American Association of Oral and Maxillofacial Surgeons.