Microvascularized fibula reconstruction for the treatment of recurrent primary meningioma: a case report with seven years of follow up

Meningiomas are typically benign tumors of mesodermal origin and are recognized as the most common extra-axial neoplasms of the central nervous system. Although they predominantly arise within the cranial cavity, a small subset occurs extracranially. Primary extracranial meningiomas located in the maxillomandibular region are extremely rare, often presenting diagnostic challenges due to their resemblance to other soft tissue or bone lesions. The surgical management of primary meningiomas at the mandible may require segmental resection. In such cases, vascularized fibular bone grafts offer an ideal reconstructive solution, when the iliac crest is not enough allowing for adequate bone length, reliable vascular supply, and compatibility with future prosthetic rehabilitation. This approach also supports three-dimensional mandibular contour restoration and soft tissue integration. This article presents a case involving the late recurrence of a previously managed primary extracranial meningioma in the mandible. It outlines the surgical strategy and outcomes, underlining the critical role of long-term monitoring in rare oncologic presentations within the maxillofacial region. Meningiomas are typically benign tumors of mesodermal origin and are recognized as the most common extra-axial neoplasms of the central nervous system. Although they predominantly arise within the cranial cavity, a small subset occurs extracranially. Primary extracranial meningiomas located in the maxillomandibular region are extremely rare, often presenting diagnostic challenges due to their resemblance to other soft tissue or bone lesions. The surgical management of primary meningiomas at the mandible may require segmental resection. In such cases, vascularized fibular bone grafts offer an ideal reconstructive solution, when the iliac crest is not enough allowing for adequate bone length, reliable vascular supply, and compatibility with future prosthetic rehabilitation. This approach also supports three-dimensional mandibular contour restoration and soft tissue integration. This article presents a case involving the late recurrence of a previously managed primary extracranial meningioma in the mandible. It outlines the surgical strategy and outcomes, underlining the critical role of long-term monitoring in rare oncologic presentations within the maxillofacial region.