Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Osteonecrosis of the jaw is a prevalent and difficult to treat condition that is associated with high morbidity. Treatment options are limited and depend on the stage of disease. Typically, early stage disease is managed with medications that increase blood flow to the mandible or hyperbaric oxygen whereas late stage disease is treated with resection of involved bone and free tissue transfer. Here we review our institutional experience treating intermediate stage ORN with debridement and local flap reconstruction. We utilized the pedicled buccal flap for exposed bone in the oral cavity and local flaps based off of the superficial temporal artery for exposed bone with cutaneous defects.
Methods: We performed a retrospective chart review of patients at our institution who underwent debridement and local flap reconstruction as the treatment of osteonecrosis. Patient demographics, clinical history, immediate and long-term outcomes were recorded.
Results: Four patients were included in this study and the average age was 70.4 years old. There were 7 total cases of reconstruction: 4 for osteoradionecrosis and 3 for bisphosphonate-related osteonecrosis. Pre-operative exposed bone was present in 85.7% cases; 1 over the mastoid tip, 3 intraorally to the maxilla, and 2 over the angle of the mandible. Local reconstruction involved 1 FAMM flap, 2 STA perforator flaps, and 4 pedicled buccal fat flaps. The average defect size was 8.0 cm2 (ranging from 3 to 12 cm2). One pedicled buccal fat flap had partial distal necrosis and required reinforcement with a FAMM flap. Otherwise, all patients did well without complication.
Conclusion: This study demonstrates how pedicled or locoregional flaps are safe and effective in the treatment of intermediate stage ORN and may be considered a low morbidity alternative to free tissue transfer.