Treatment Challenges in Soft Tissue Reconstruction in Patients With MRONJ - The Nasolabial Flap

Antiresorptive drugs (e.g., bisphosphonates, denosumab) are crucial in the treatment of oncological diseases. However, these antiresorptive drugs can cause medication-related osteonecrosis of the jaw (MRONJ). MRONJ is a challenging disease regarding the soft tissue defect treatment. There are various surgical reconstruction techniques. One of them is the nasolabial flap.The present case report describes a 76-year-old female suffering from MRONJ leading to a progressive abscess of the mandible as well as an intra/extraoral fistula with extent to the chin region. Surgical splitting of the abscess was performed immediately. In the further course, a surgical decortication of the mandible with soft tissue defect treatment using a mucoperiosteal flap was performed. Intraoperatively, the bone of the mandible showed severe necrotic defects in multiple locations. Therefore, a continuity resection of the mandible with an insertion of a reconstruction plate was performed. Postoperatively, however, there was a progressive wound dehiscence. Due to the persisting regression of the gingival mucosa, the soft tissue defect was treated with a caudally pedicled bilateral nasolabial flap. The further clinical follow-up showed no recurrence of MRONJ with a well-healed nasolabial flap.In addition to mucoperiosteal flaps and microvascular reconstructions, the nasolabial flap can be a sufficient surgical therapy for intraoral soft tissue defect reconstruction.