[Modified submental artery island flap for reconstruction of mandibular defects caused by medication-related osteonecrosis of the jaw: technical note and clinical outcomes].

Objective

To summarize the key surgical techniques of the modified submental artery island flap for repairing tissue defects following surgery for mandibular medication-related osteonecrosis of the jaw (MRONJ), and to retrospectively evaluate the therapeutic outcomes.

Methods

A total of 116 patients with mandibular MRONJ who underwent surgical treatment at the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Peking University International Hospital, and Baoding Second Hospital from June 2021 to September 2025 were included. All patients underwent saucer-like osteotomy preserving mandibular continuity, combined with a modified submental artery island flap for bone defect cavity filling and wound closure. Baseline data (age, sex), clinical data (primary disease, medication strategy, AAOMS stage), and surgical intervention factors (fluorescence guidance, reconstruction plate placement, flap transfer method) were retrospectively analyzed. Regular follow-up was conducted postoperatively via clinical (3 weeks, 6 weeks, and 12 weeks) and imaging examinations (12 weeks) to assess soft tissue and bone wound healing, and to evaluate the overall cure rate.

Results

The modified submental artery island flap was utilized to reconstruct tissue defects and achieve wound closure in a series of 116 mandibular MRONJ patients. Among them, 52 were male and 64 were female, with a mean age of 64.9 years. Lung cancer, breast cancer, and prostate cancer were the most common primary diseases. There were 29 patients with AAOMS stage Ⅱ and 87 with stage Ⅲ MRONJ. Seventy-six received antiresorptive agents alone, and the remaining 40 patients received a combination of antiresorptive and antiangiogenic agents. All 116 patients underwent saucer-like osteotomy preserving mandibular continuity, with 66 patients receiving reconstruction plates to enhance the strength of residual mandibular bone. Necrotic bone resection was performed based on clinical judgement in 94 patients, whereas autofluorescence-guided resection was used in 22 patients. Of the 116 cases, 105 were successful and 11 failed, translating to an overall cure rate of 90.5%. Univariate and multivariate statistical analyses revealed that none of the variables examined had a statistically significant effect on treatment outcome.

Conclusions

The modified submental artery island flap provides an effective approach for reconstructing mandibular MRONJ defects, enabling reliable soft tissue coverage and favorable clinical outcomes. This technique shows considerable potential for widespread application in preserving mandibular continuity and function, presenting a safe and effective option in the surgical management of MRONJ.