Outcomes of Bisphosphonate-Related Osteonecrosis Following Head and Neck Free-Flap Reconstruction

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) can be refractory to conservative management. Definitive segmental resection with microvascular free-flap reconstruction is increasingly used, yet outcomes remain underreported. We conducted a single-institution retrospective review (2014-2022) of patients with BRONJ undergoing free-flap reconstruction. Exposures included inciting medication and smoking history. Primary outcomes were recurrence and orocutaneous fistula. Ten patients met criteria; zoledronic acid was the most common exposure (60%). Reconstructions included fibular (n = 8) and scapular (n = 2) free flaps. Eight patients (80%) did not have recurrence of osteonecrosis after a single operation over the span of follow-up. Two had recurrent osteonecrosis, one of which developed a postoperative fistula requiring reoperation. In our cohort of patients with advanced BRONJ, segmental resection with immediate free-flap reconstruction achieved high single-stage cure with low complication rates.