Mending Jaws with Leg Bones- Treatment for Osteonecrosis of the Jaw
30 years ago, patient Mary was taking a medication classified as a bisphosphonate. Bisphosphonates are antiresorptive medications used to prevent the loss of bone density. She developed osteonecrosis of the jaw (ONJ) after taking the medication for many months.
Currently, it is still unclear why patients taking antiresorptive medications develop ONJ. Medical professionals believe it may be due to a decrease in the bone’s ability to repair itself, a decrease in blood vessel formation, or the possible effects of infection.
Over the next 30 years, Mary developed invasive dental disease, resulting in the need for multiple extractions and finally an upper jaw that “slowly melted away”. She was treated with dental implants that were anchored into her cheek bones to support her dentures.
Mary’s biggest fear was her dentures falling out while she was out with friends or eating at a restaurant.
In order to achieve optimal results and be rid of the disease progression, radical resection and immediate free flap reconstruction was recommended. Unfortunately, Mary struggled to find a surgeon who was able to perform this advanced procedure. Finally, Mary came across Dr. Thaddeus Boucrée and Dr. Eric Chang from the Institute for Advanced Reconstruction. Together, they were able to provide her relief.
During a 10-hour surgery, her diseased upper jaw, along with her failing implants were removed. Mary’s leg bone was used to reconstruction her upper jaw. Using virtual surgical planning weeks before the scheduled operation, a 3D computer program helped these surgeons confirm that her leg bone (fibula) could be used to successfully reconstruct a new maxilla (upper jaw).
Pre-surgical planning, careful and delicate surgical dissection along with surgical expertise, contributed great results. Mary can’t wait to get back to her active social life and the gym!
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