Defect reconstruction in stage 3 medication-related osteonecrosis of the posterior maxilla using the superiorly-based facial artery musculomucosal flap: A case report

In stage 3 medication-related osteonecrosis of the jaw (MRONJ) of the posterior maxilla, removal of the necrotic bone and infected soft tissue leads to large defects with oroantral communications. It is essential to cover the exposed bone and close the communications by using well vascularized local flaps for good long-term results. Here, we describe a case of stage 3 MRONJ of the posterior maxilla in a 76-year-old male patient who had been taking bisphosphonate and denosumab for skeletal metastasis of prostate cancer. The patient eventually underwent extensive surgery consisting of removal of the necrotic bone and infected soft tissue and developed a large oroantral communication. A superiorly-based facial artery musculomucosal (FAMM) flap was used for reconstruction of the large maxillary defect. He obtained complete resolution of MRONJ without leaving facial deformity or hypoesthesia at more than 10 months postoperatively and resumed denosumab therapy. Thus, the superiorly-based FAMM flap should be considered a reliable option for defect reconstruction in stage 3 maxillary MRONJ with functionally and esthetically promising results.