Microsurgical reconstruction for radiation- and bisphosphonate-induced mandible osteonecrosis based on patient-specific physiopathologic mechanisms.

Background: Radiation- and bisphosphonate-induced mandible osteonecrosis have distinct underlying physiopathologic mechanisms, but both can constitute a serious problem and lead to functional impairment and facial disfigurement.

Methods And Results: We describe different clinical situations related to several grades of osteonecrosis, where different options of free transfer should be considered based on case-specific physiopathologic mechanisms. We propose a simple clinical grading system to predict the best treatment option.

Conclusions: For patients with advanced refractory disease, pathologic fracture, orocutaneous fistula, and severe osteolysis, resection associated with microvascular reconstruction seems to be a valid option that stops the underlying pathophysiology of overinfected avascular bone necrosis. Physicians who understand the specific physiopathologic mechanisms of each case can incorporate them into the assessment of the required reconstruction and treatment plans.