THE USE OF PERIOSTEAL FLAP IN MANDIBLE PRIMARY RECONSTRUCTION AFTER SEGMENTAL RESECTION IN MEDICATION-RELATED OSTEONECROSIS PATIENT: CASE REPORT

Background: The treatment of medication-related osteonecrosis of the jaws is challenging. Mandible segmental resection is the main treatment method for advanced stage 2 and stage 3 medication- related osteonecrosis of the mandible. This brings to the large continuity defects of the mandible, decreasing the life quality of the patients. Method: In this study, a modified technique of mandible defect reconstruction, after segmental resection, with only a reconstruction plate, is described. In this technique, the periosteal flap is used for double-layer closure of the intraoral wound. Double-layer isolation of the reconstruction plate from the oral cavity prevents intraoral wound dehiscence and plate exposure. Also, for the bone fragments fixation, prebended 2.3mm reconstructive plate on the 3D-printed individual model of the patient’s mandible was used. The use of a prebended plate reduces the operation time and increases the precision of fixation of mandible fragments in the correct position. Results: After intraoral sutures removal on 14 days, there was a dehiscence of a few intraoral sutures on mucoperiosteal flaps. There was partial exposure of the periosteal flap, which secured the underlying reconstructive plate. Exposed periosteal flap spontaneously epithelialized during 1 month. The postoperative follow-up period was nine months. During this period no complications were noted Conclusion: Within the limitations of the study, this method can be used as an effective and predictable method for the primary reconstruction of the mandible with only a reconstruction plate in medication-related osteonecrosis of the jaws patients.