Reconstrução mandibular com enxerto não vascularizado de fíbula associado a oxigênoterapia hiperbárica após ressecção de fibroma desmoplásico

Abstract

Desmoplastic fibroma, an intraosseous counterpart of desmoid-type soft tissue fibromatosis, is a relatively rare condition characterized by aggressive behavior and moderate to high recurrence rates. The clinical presentation is often limited and the symptoms are nonspecific, with the diagnosis being established through pathological examination. The main treatment consists of surgery, with emphasis on complete resection of the tumor. The rehabilitation of these patients with gnathic bone defects represents a substantial challenge and mandibular reconstruction, in this case, emerges as the most effective approach to restore the patient's essential biomechanical functions. Vascularized bone grafts are widely recognized as the gold standard for mandibular reconstruction, however there are specific situations in which the limitations associated with this approach make non-vascularized bone grafts a viable and strategic option for such reconstruction. In this study, we present the case of a female patient diagnosed with desmoplastic fibroma in the anterior region of the mandible. The tumor was treated through partial resection with safety margins, followed by reconstruction using free autogenous bone graft from the fibula in a second surgical procedure. As an adjuvant, hyperbaric oxygen therapy was used in order to assist the dissolution of oxygen in the plasma and provide recovery of damaged tissues, inhibit bacterial growth and alleviate inflammatory processes. Four months after reconstructive surgery, satisfactory integration of the graft was observed. The patient will be rehabilitated using implant- supported prostheses to restore chewing function. In this context, non-vascularized fibula bone grafts emerge as a judicious option for the reconstruction of selective mandibular defects, especially in scenarios where financial and surgical resources are limited, offering satisfactory results, contributing significantly to the effective rehabilitation of patients.