case_images: PMC10860903_01
case_images: Preoperative CT bone window. (A and B) Osteomyelitis of the right mandibular body with bone sequestration (white arrow). (C) Sinus tract in the right submandibular region (white arrow) and cellulitis in the right submandibular area.
case_images: cureus-0016-00000052212-i01.jpg
case_images: PMC10860903_01_cureus-0016-00000052212-i01.jpg
case_images: FIG1
case_images: Following this treatment period, a maxillofacial computed tomography (CT) scan was conducted, revealing the progression of mandibular osteonecrosis in comparison to previous examinations (Figure 1).
case_images: Right submandibular sinus tract with pre-operative excision marking
case_images: cureus-0016-00000052212-i02.jpg
case_images: PMC10860903_01_cureus-0016-00000052212-i02.jpg
case_images: FIG2
case_images: Simultaneously, fistulectomy of the submandibular cutaneous fistula was carried out using a submandibular approach (Figure 2).
case_images: Reconstruction with a fibula-free flap. (A) 3D cutting guides in the osteo-muscular left fibula; (B) Fibula flap harvesting; (C) Fixation of the remaining mandible through osteosynthesis using a pre-molded plate
case_images: cureus-0016-00000052212-i03.jpg
case_images: PMC10860903_01_cureus-0016-00000052212-i03.jpg
case_images: FIG3
case_images: The fibula was fixated to the remaining mandible by a pre-molded plate (Figure 3).
case_images: One-year post-surgery CT scan. (A, B, and C) Axial CT bone window illustrating robust osseointegration of the fibula-free flap. (D, E, and F) CT bone window with 3D reconstruction
case_images: cureus-0016-00000052212-i04.jpg
case_images: PMC10860903_01_cureus-0016-00000052212-i04.jpg
case_images: FIG4
case_images: At the one-year follow-up, the osseointegration of the vascularized fibula was assessed using a maxillofacial CT scan, revealing robust osseointegration without signs of osteomyelitis, osteonecrosis, or alterations in soft tissues (Figure 4).
case_images: Postoperative results at one year. (A) Left fibula donor site with a linear scar; (B) Frontal facial view, showing no asymmetry; (C) Right profile view demonstrating a well-defined mandible contour
case_images: cureus-0016-00000052212-i05.jpg
case_images: PMC10860903_01_cureus-0016-00000052212-i05.jpg
case_images: FIG5