Modified Submental Island Flap for the Surgical Treatment of Four Patients with Stage 3 Medication-Related Osteonecrosis of the Mandible

Abstract Medication-related osteonecrosis of the jaw (MRONJ) in its advanced stages requires surgical treatment to resolve the pathology and to achieve good long-term results. After complete removal of the necrotic bone and infected soft tissue, it is essential to cover the exposed bone using well-vascularized soft tissue such as local, regional, and microvascular free flaps. The purpose of this study was to evaluate the technical usefulness of the modified submental island flap (SIF) for covering the large bone and soft tissue defects of the mandible after decortication in patients with stage 3 MRONJ. The modified SIF, which consists of the conventional SIF plus the mylohyoid muscle, was used for reconstruction of the large defects in the mandible in four patients, and no problems were noted in the treated areas at 12 months postoperatively. Despite the limited number of cases, the modified SIF was found to be a robust flap requiring only a single-stage procedure and resulting in excellent coverage of large defects with sufficient blood supply for a good bone-healing process.