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Case Reports
. 2015 Jul-Sep;30(3):280-2.
doi: 10.4103/0972-3919.158549.

Role of (99m)Tc-methylene diphosphonate bone scan in the evaluation of the viability of the bone flap in mandibular reconstruction in patients with oromaxillofacial malignancies

Madhur Kumar Srivastava  1 , Prasanth Penumadu  2 , Dinesh Kumar  3 , Nandini Pandit  1
Affiliations
Case Reports

Role of (99m)Tc-methylene diphosphonate bone scan in the evaluation of the viability of the bone flap in mandibular reconstruction in patients with oromaxillofacial malignancies

Madhur Kumar Srivastava et al. Indian J Nucl Med. 2015 Jul-Sep.

Abstract

Osteo-cutaneous flap are commonly used for reconstruction of bone defect after oncology surgery. The success of surgery depends on the viability of the bone flap. Bone scan is a known, but less performed method, to look for viability of bone flaps. We describe a case of 50-year-old lady, presenting with squamous cell carcinoma of left buccal mucosa (cT4N1M0) involving the skin and mandible. She underwent left segmental mandibulectomy and upper alveolectomy with neck dissection, followed by reconstruction using a fibular osteo-cutaneous flap and anterolateral thigh free flap. On postoperative day 10, the intraoral flap showed signs of nonviability. The patient was sent to nuclear medicine for assessment of viability of the free fibula flap. The patient underwent three phase (99m)Tc-methylene diphosphonate (MDP) bone scan and single-photon emission computerized tomography. Computerized tomography showing good tracer uptake in fibula confirming viability. The case reflects the use of (99m)Tc-MDP in viability assessment of the bone flap.

Keywords: 99mTc-methylene diphosphonate; bone scan; fibular graft; osteo-cutaneous flap; viability.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
(a) Preoperative image of buccal carcinoma infiltrating the skin and mandible. (b) Intra-operative image after hemimandibulectomy. (c) Fibular graft harvested from the patient. (d) Intra-operative image showing the graft with plate and screws in situ. (e) Necrosis of intraoral graft on postoperative day 10
Figure 2
Figure 2
(a) Coronal and, (b) Saggital SPECT-CT images of skull showing good tracer uptake in the fibular graft with plate in situ. (c) Planar image showing good tracer uptake in the graft on left side suggestive of viability of the graft
See this image and copyright information in PMC

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