Osteosarcoma is the most common malignant bone tumour, but about only 8% present primarily in the jaw. Complete excision is the treatment of choice whenever feasible. A 50 year-old female, with confirmed diagnosis of monostotic fibrous dysplasia of the mandible, presented at the clinic because of enlargement of the lesion, with aesthetic deformity and paresthesia of the lower lip. CT imaging suggested sarcomatous transformation. Otherwise, past history was unremarkable. Biopsy confirmed low-degree osteosarcoma of the left mandibular body. Staging work-up did not show dissemination. She was admitted for surgical wide excision, ipsilateral selective cervical dissection, and primary reconstruction using fibular free flap, with no skin paddle (osteomuscular) and terminal anastomoses to the facial vessels. Extemporaneous histology of a resected lymph node showed no regional metastasis. Primary lesion margins were free of disease. Follow-up evaluations showed excellent recovery, and at 8 month post-op she began oral rehabilitation with endosseous implants, with no adverse surgical or pathological events. At last follow-up, 11 months after surgery, she was in complete remission. Furthermore, patient’s successful outcome restored her quality of life with no significant limitations or deformities, thus exemplifying the utility and advantages of this technique as primary reconstruction and rehabilitation.
Osteosarcoma of the mandible and primary reconstruction with fibular flap
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