Fibula flap reconstruction for maxillary stage 3 medication-related osteonecrosis of the jaw from recipient and donor site perspectives: a preliminary single-center study.

Background: While the surgical treatment of mandibular stage 3 medication-related osteonecrosis of the jaw (MRONJ) is well-documented, research on maxillary stage 3 MRONJ is limited. Antiresorptive medications can induce MRONJ and atypical femoral fracture (AFF), but their impact on the feasibility of using fibula flaps for reconstruction remains controversial. This study aimed to assess the surgical outcomes and functional recovery of fibula flap reconstruction for maxillary stage 3 MRONJ, considering both recipient and donor site outcomes.

Methods: This retrospective study included patients with maxillary stage 3 MRONJ who underwent fibula flap reconstruction. Demographic and clinical features, postoperative complications, long-term outcomes and functional recovery of both recipient and donor sites were analyzed. Long-term outcomes included the survival of fibula flaps, the incidence of fibula graft or tibia fractures, recurrence of MRONJ, and patient survival status. Function assessments focused on speech, swallowing, and ankle joint.

Results: Seven patients (two with multiple myeloma, five with bone metastases) were included. Two patients experienced delayed healing at the donor site, both of whom recovered within two months postoperatively. All fibula flaps survived with primary healing. There were no recurrences of MRONJ or fractures of fibula graft or tibia. The mean speech function score was 28.00 ± 12.03, the mean swallowing function score was 2.86 ± 2.79, the mean pain score of donor site was 2.71 ± 2.29, and the mean ankle function score was 94.43 ± 4.35.

Conclusion: Fibula flap reconstruction is feasible for maxillary stage 3 MRONJ, yielding satisfactory surgical outcomes and functional recovery.