Mandibular Reconstruction with Deep Circumflex Iliac Artery Osteomyocutaneous Free Flap in a Severe Case of Osteoradionecrosis of the Mandible: A Case Report

Authors

  • Namkabir Singh Department of Oral & Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya, 50603 Kulala Lumpur, Malaysia
  • Kong Chee Kwan Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Universiti Malaya, 50603 Kulala Lumpur, Malaysia
  • Siti Mazlipah Ismail Department of Oral & Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya, 50603 Kulala Lumpur, Malaysia
  • Alizan Abdul Khalil Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Universiti Malaya, 50603 Kulala Lumpur, Malaysia

DOI:

https://doi.org/10.24191/cos.v11i2.27509

Keywords:

osteoradionecrosis, mandible, radiotherapy, reconstruction

Abstract

Introduction
Osteoradionecrosis (ORN) can be accompanied by several signs such as tissue loss, exposed necrotic bone, presence of fistula, pain, infection, trismus, and even pathological fracture of bones. Early-stage ORN is usually managed conservatively with medication while severe progression of the disease requires aggressive treatment such as free flap reconstruction surgery.

Case report
This case involves a 52-year-old lady who was previously diagnosed with well-differentiated squamous cell carcinoma of the left side of the tongue (T3 N2b M0) and had undergone surgery, followed by 6 cycles of chemotherapy and 30 cycles of radiotherapy. She presented to our centre complaining of pain and pus discharge over her lower jaw for the past 3 months. Upon examination, the skin around her neck and chin was erythematous, firm and tense, limiting not just her mouth opening but also the flexibility of her neck movement. She also had two oral-cutaneous fistulas, at the submental and submandibular region, with thick pus discharge. Intraorally, there was a broken and exposed titanium plate. She was subjected to segmental resection of the anterior mandible together with fistulectomy, reconstruction with deep circumflex iliac artery osteomyocutaneous flap and tracheostomy.

Conclusion
Despite not being a life-threatening disease, ORN has a significant impact on the well-being of patients, leaving them with possible disfiguration, pain and chronic wounds. This case report summarizes the journey of our patient from initial presentation, surgery, and post operative follow-up, highlighting the rare need for aggressive treatment in managing advanced ORN.

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Published

2024-09-01

How to Cite

Singh, N., Chee Kwan, K., Ismail, S. M., & Abdul Khalil, A. (2024). Mandibular Reconstruction with Deep Circumflex Iliac Artery Osteomyocutaneous Free Flap in a Severe Case of Osteoradionecrosis of the Mandible: A Case Report. Compendium of Oral Science, 11(2), 142–150. https://doi.org/10.24191/cos.v11i2.27509

Issue

Vol. 11 No. 2 (2024): Compendium of Oral Science

Section

Case Report

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