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Case Reports
. 2023 Jul-Dec;13(2):236-239.
doi: 10.4103/ams.ams_63_23. Epub 2023 Dec 19.

Microvascularized Fibular Bone Grafting for the Treatment of Mandibular Expansive Osseous Dysplasia - A Case Report

Camila de Oliveira Barbeiro  1 , Mario Henrique Arruda Verzola  2 , Roberto Henrique Barbeiro  1 , Wilson Tadao Tachibana  3 , Jorge Esquiche León  4 , Andreia Bufalino  1
Affiliations
Case Reports

Microvascularized Fibular Bone Grafting for the Treatment of Mandibular Expansive Osseous Dysplasia - A Case Report

Camila de Oliveira Barbeiro et al. Ann Maxillofac Surg. 2023 Jul-Dec.

Abstract

Rationale: Osseous dysplasia (OD) is a benign fibro-osseous lesion classified as periapical, focal or florid with some rare cases being diagnosed as expansive OD.

Patient concerns: A 43-year-old female presented with gross mandible expansion and tooth displacement.

Diagnosis: Imaging scans revealed an expansive lesion in the anterior mandible, with varying opacity in the central region, and other smaller lesions in the region of teeth #37 and #47, consistent with expansive OD.

Treatment: Surgical resection followed by immediate reconstruction of the mandibular defect using a microvascularized fibular graft.

Outcomes: The patient had a 4-year follow-up, with adequate mandibular bone continuity, mastication, swallowing, and speaking ability reestablished.

Take-away lessons: Immediate reconstruction after large surgical resection is required as tissues retract over time, hampering late reconstructions. Microvascularized fibular graft aims at adequate and functional rehabilitation with osseointegrated implants and long-term follow-up is needed as florid OD may evolve into expansive OD.

Keywords: Bone dysplasias; case report; florid cemento-osseous dysplasia; mandibular reconstruction; vascular grafting.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Initial panoramic radiograph with multiquadrant radiolucent lesions, radiopaque halo around tooth 37 and near tooth 34. Radiolucent lesion with radiopaque areas near teeth 11, 21, 22 and 23
Figure 2
Figure 2
(a) Intraoral expansive lesion, (b) Buccal and lingual mucosal involvement and teeth displacement, (c) Sagittal reconstruction, (d) Coronal reconstruction, (e) Panoramic reconstruction of hypodense lesion with hyperdense areas from tooth #35 to #45, and two lesions in the mandibular body near teeth #38 and #48, (f) Irregularly shaped trabeculae of medullary bone in a fibrous stroma, (g) Psammomatoid bodies in fibroblastic stroma (H and E, ×10)
Figure 3
Figure 3
Surgical procedures. (a-c) Previous prototyping, (d) Transcervical access with special attention to the facial artery and jugular veins, (e) Mid-lateral incision over the fibula, (f) Fixation of the fibula to the pre-modeled plate, (g and h) Placement of the reconstruction plate, bone tissue, periosteum, and vessels in the mandible recipient site, (i) Immediate postoperative aspect
Figure 4
Figure 4
Follow-up at 4 years. (a) Clinical aspect, (b) Panoramic reconstruction, (c) Cross-sectional
See this image and copyright information in PMC

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