Virtual Surgical Planning for Bisphosphonate-Related Osteonecrosis of the Jaw: A Valuable Application in Advanced Cases.

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a rare but potentially devastating complication of extended use of bisphosphonates. fibula free flaps (FFFs) are the gold standard of mandibular reconstruction. Virtual surgical planning (VSP) is a technique that utilizes high-definition three-dimensional reconstructions that enable the production of highly accurate intra-operative surgical guides and templates that help guide osteotomies and fibula contouring.  The aim of this report is to highlight the value of VSP in the surgical management of advanced BRONJ. We report a case study of a woman with advanced BRONJ that required an angle-to-angle mandibular resection with subsequent reconstruction with an FFF. VSP was used to improve the accuracy of the reconstruction and minimize ischemia time. We present the first reported case of the successful implementation of VSP for the planning of FFF reconstruction for a woman with advanced symptomatic BRONJ that had failed conservative measures.

Necrotizing Lip Infection Causing Septic Thrombophlebitis of the Neck: A Rare Variant of Lemierre Syndrome.

Lemierre syndrome is an uncommon condition in which internal jugular vein thrombosis presents after recent oropharyngeal infection. Frequently, this is accompanied by septic emboli. This report outlines a variant of this disease process, with septic thrombophlebitis of the neck associated with a necrotizing skin infection of the lower lip and chin. A 25-year-old man with lower lip and chin swelling, initially managed with intravenous antibiotics, progressed to the development of a left facial vein thrombus, septic emboli to the lungs, and a necrotizing lower lip and chin infection that was managed with debridement, thrombectomy, and prolonged hemodynamic and pulmonary support. A necrotizing skin infection with thrombus of the jugular system and septic emboli is a very rare variant of Lemierre syndrome. Early recognition of an infection with septic emboli and/or necrotizing pathobiological findings allows for prompt antibiotic and surgical therapy, minimizing the mortality of these potentially lethal infections.