Reconstrução microcirúrgica para osteonecrose grave da mandíbula
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A osteonecrose da mand�bula induzida por radia��o e bisfosfonatos tem mecanismos fisiopatol�gicos subjacentes distintos, mas ambas podem constituir um problema grave e levar a comprometimento funcional e desfigura��o facial. Os objetivos do tratamento s�o a elimina��o da dor e das infe��es associadas, a melhoria da fun��o oral (abertura, fala, mastiga��o) e a preven��o de deformidades (f�stulas, exposi��es �sseas, defeitos �sseos, fraturas patol�gicas). Para doentes com doen�a refrat�ria avan�ada, fratura patol�gica, f�stula orocut�nea e oste�lise grave, a ressec��o associada � reconstru��o microvascular parece ser uma op��o v�lida que interrompe a fisiopatologia subjacente da necrose �ssea avascular com sobreinfec��o. Neste livro, descrevemos diferentes situa��es cl�nicas relacionadas com v�rios graus de osteonecrose, nas quais diferentes op��es de transfer�ncia livre devem ser consideradas com base nos mecanismos fisiopatol�gicos espec�ficos de cada caso. Propomos um sistema de classifica��o cl�nica simples para prever a melhor op��o de tratamento.
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