Surgical management of Osteosarcoma arising from Fibrous Dysplasia in the Jaw – A Case Study

A 37-year-old man presented with a challenging case. Five years prior, he underwent surgery to remove fibrous dysplasia from his right lower jaw. Unfortunately, the condition recurred and transformed into a more aggressive tumor, histologically diagnosed as osteosarcoma. The tumor grew significantly, causing difficulty eating, breathing, and speaking, due to limited jaw mobility and tongue function. Imaging revealed the extensive tumour compressing his airway.

Given the urgency, surgery was planned. To address the large bone defect and restore function, a custom-made implant was chosen to replace the diseased jawbone. This implant was designed to allow immediate placement of a prosthetic device. A vascularized fibula flap, containing both bone and skin tissue from the leg, was used for reconstruction. The fibula’s blood vessels would be meticulously connected to vessels in the face to ensure blood supply to the transplanted tissue. The surgery involved removing the entire tumor and meticulous preparation of blood vessels for connection (anastomosis) with the vessels in the fibula flap.

Could you comment on the approach? Do you have any other approach? 

A case of osteosarcoma in a 37-year-old man who had been operated five years ago to remove fibrous dysplasia from the right lower jaw which recurred and transformed into osteosarcoma.
A case of osteosarcoma in a 37-year-old man who had been operated five years ago to remove fibrous dysplasia from the right lower jaw which recurred and transformed into osteosarcoma.
A case of osteosarcoma in a 37-year-old man who had been operated five years ago to remove fibrous dysplasia from the right lower jaw which recurred and transformed into osteosarcoma.
A case of osteosarcoma in a 37-year-old man who had been operated five years ago to remove fibrous dysplasia from the right lower jaw which recurred and transformed into osteosarcoma.
The size of the lesion was such that the patient had difficulty feeding and breathing.
The size of the lesion was such that the patient had difficulty feeding and breathing.
He could not open his mouth and his tongue was indistinct.
He could not open his mouth and his tongue was indistinct.
3D visualization with the reconstruction plate was used in the previous operation
3D visualization with the reconstruction plate was used in the previous operation
From the axial sections you can distinguish the size of the tumor and the convergence of the airway.
From the axial sections you can distinguish the size of the tumor and the convergence of the airway.
Due to the seriousness of the situation, it was decided to immediately deal with a prefabricated custom-made implant for the replacement of the lower jaw using a vascularized fibula flap and skin which was adapted to the implant which also brought the infrastructure for immediate prosthetic restoration.
Due to the seriousness of the situation, it was decided to immediately deal with a prefabricated custom-made implant for the replacement of the lower jaw using a vascularized fibula flap and skin which was adapted to the implant which also brought the infrastructure for immediate prosthetic restoration.
The removed tumor
The removed tumor
The prepared vessels for the anastomosis
The prepared vessels for the anastomosis
The palpable fibula and skin flap
The palpable fibula and skin flap
Adaptation of the flap to the implant
Adaptation of the flap to the implant
The patient on the first postoperative day
The patient on the first postoperative day
Postoperative 3DCBCT
Postoperative 3DCBCT
And the cuts
And the cuts
The patient with open and closed mouth. We see the massive skin flap that due to the urgency we were not able to use the Forte and Integra technique
The patient with open and closed mouth. We see the massive skin flap that due to the urgency we were not able to use the Forte and Integra technique
The patient 8 weeks later
The patient 8 weeks later
The patient before and after
The patient before and after

Case contributed by

Dr. Zoe Nicolaou

Dr. Zoe Nicolaou

Oral & Maxillofacial Surgeon, Cyprus
President Elect
ICMFS 

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