Submental Flap Reconstruction for Mandibular Osteomyelitis in an Adolescent Patient With Osteopetrosis: A Case Report

Osteopetrosis is a rare group of skeletal disorders characterized by impaired osteoclastic bone resorption and abnormal bone remodeling. Severe forms may result in bone marrow failure, extramedullary hematopoiesis, cranial nerve dysfunction, and skeletal complications. Mandibular osteomyelitis is a particularly challenging complication because impaired bone remodeling and compromised vascularity may contribute to persistent infection, osteonecrosis, and poor wound healing. We report the case of a 14-year-old girl with severe osteopetrosis, reported in her previous medical records as CLCN7-related, complicated by severe hematological abnormalities, hepatosplenomegaly, neurological complications, and chronic mandibular osteomyelitis with osteonecrosis. The patient underwent surgical removal of necrotic mandibular bone followed by reconstruction of the anterior floor-of-mouth soft-tissue defect using a submental flap. Preoperative computed tomography angiography confirmed patency of the relevant facial and submental vessels and supported the planned reconstruction. Given the patient's anemia, thrombocytopenia, malnutrition, and limited physiological reserve, a limited surgical approach was selected to avoid more extensive mandibular resection. Following surgery, significant postoperative airway edema required continued mechanical ventilation and pediatric intensive care unit management. After multidisciplinary postoperative care, successful extubation was achieved on the third postoperative day, followed by transfer to the maxillofacial surgical ward in a hemodynamically and respiratory stable condition with satisfactory early postoperative healing. This case highlights the challenges of managing mandibular osteomyelitis in patients with severe osteopetrosis and significant systemic disease. Individualized surgical planning and multidisciplinary perioperative management are essential in this setting. Submental flap reconstruction provided vascularized soft-tissue coverage in the immediate postoperative period while avoiding a more extensive reconstructive procedure.