Medial Femoral Condyle Free Flap for Medication Related Osteonecrosis of the Jaw
Abstract
The incidence of medication-related osteonecrosis of the jaw (MROJ) is 0.1% among patients using oral bisphosphonates. While uncommon, this serious complication leads to painful jaw lesions, making activities of daily living such as eating, drinking, and speaking difficult. A 57-year-old female presented with MROJ following IV bisphosphonate treatment during chemotherapy for breast cancer. The patient remained symptomatic after rounds of antibiotics and debridement, and radiographic studies revealed osteonecrosis of the left angle of the mandible. The operation involved a vascularized medial femoral condylar free flap with a muscle paddle under the oral mucosa. The intraoral lesion was debrided first, resulting in a 2x1.5 cm defect. A submandibular incision was made, and the facial artery and vein were identified, while a tunnel was created to the intraoral defect. The right medial femoral condyle was excised, along with a segment of the vastus medialis and the descending geniculate artery (DGA) and vein. The flap was tunneled and secured with two 7-mm self-drilling screws. Notably, the muscle portion of the flap was draped over the periosteum at the superior aspect of the mandible underneath the oral exposure, and the oral mucosal tissues were closed. Microvascular surgery was utilized for the anastomosis of the vessels. The patient tolerated the procedure well and was seen with no complications 3 months post-operatively. Large bony deformities of the face are often covered with fibular, iliac crest, or scapular free flaps. However, in smaller deformities, these options may be excessive. The advantages of using a medial femoral condylar flap for the case described above include its small size, pliability for reshaping, and the incorporation of a large vascularized periosteum that aids in bone recovery. Additionally, the use of a segment of the vastus medialis provided vascularized soft tissue coverage over the intraoral repair.
Start Time
16-4-2025 1:30 PM
End Time
16-4-2025 4:00 PM
Presentation Type
Poster
Presentation Category
Health
Student Type
Clinical Doctoral Student (e.g., medical student, pharmacy student)
Faculty Mentor
Dr. Jeremy Powers
Faculty Department
Plastic Surgery
Medial Femoral Condyle Free Flap for Medication Related Osteonecrosis of the Jaw
The incidence of medication-related osteonecrosis of the jaw (MROJ) is 0.1% among patients using oral bisphosphonates. While uncommon, this serious complication leads to painful jaw lesions, making activities of daily living such as eating, drinking, and speaking difficult. A 57-year-old female presented with MROJ following IV bisphosphonate treatment during chemotherapy for breast cancer. The patient remained symptomatic after rounds of antibiotics and debridement, and radiographic studies revealed osteonecrosis of the left angle of the mandible. The operation involved a vascularized medial femoral condylar free flap with a muscle paddle under the oral mucosa. The intraoral lesion was debrided first, resulting in a 2x1.5 cm defect. A submandibular incision was made, and the facial artery and vein were identified, while a tunnel was created to the intraoral defect. The right medial femoral condyle was excised, along with a segment of the vastus medialis and the descending geniculate artery (DGA) and vein. The flap was tunneled and secured with two 7-mm self-drilling screws. Notably, the muscle portion of the flap was draped over the periosteum at the superior aspect of the mandible underneath the oral exposure, and the oral mucosal tissues were closed. Microvascular surgery was utilized for the anastomosis of the vessels. The patient tolerated the procedure well and was seen with no complications 3 months post-operatively. Large bony deformities of the face are often covered with fibular, iliac crest, or scapular free flaps. However, in smaller deformities, these options may be excessive. The advantages of using a medial femoral condylar flap for the case described above include its small size, pliability for reshaping, and the incorporation of a large vascularized periosteum that aids in bone recovery. Additionally, the use of a segment of the vastus medialis provided vascularized soft tissue coverage over the intraoral repair.