Segmental mandibulectomy for mandibular osteoradionecrosis in an older adult with underweight status

Refractory osteomyelitis can lead to recurrent cellulitis and pathological fractures in patients with advanced mandibular osteoradionecrosis (ORN), the optimal treatment for which remains to be established. In addition, difficulties in intake due to trismus and severe pain caused by mandibular ORN may lead to malnutrition and underweight. Therefore, refeeding syndrome (RFS) should be considered when highly invasive surgical procedures are performed. In this report, we discuss the case of an 80-year-old woman with underweight status who had undergone radiotherapy for oropharyngeal malignant melanoma, following which she developed severe pain and a pathological fracture in the right mandible. Given her advanced age and cognitive decline, decisionmaking regarding the treatment plan was difficult. After repeated consultations with the patient and her family members, the treatment priorities were established as pain control, infection control, and increased mouth opening. A segmental mandibulectomy was performed. After nutritional intake was initiated postoperatively, a marked decrease in serum potassium and phosphorus levels was observed. Because there were no symptoms suggestive of RFS, imminent RFS was considered. Appropriate management in accordance with the National Institute for Health and Care Excellence guidelines prevented progression to RFS. Overall, surgery was successful in achieving the initial treatment objectives, and the patient exhibited a general improvement in quality of life. Careful perioperative management for RFS prevention should be considered necessary when performing surgical procedures for advanced mandibular ORN, especially in older adults.

Automated summary

Refractory osteomyelitis can lead to complications in advanced mandibular osteoradionecrosis (ORN), such as recurrent cellulitis and pathological fractures. The optimal treatment for such conditions has not been established yet. Difficulty in intake and severe pain caused by mandibular ORN may result in malnutrition and underweight. Refeeding syndrome (RFS) should be considered in invasive surgical procedures.