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Aspiration and ingestion of dental foreign objects are infrequent, but they can occur at large multidisciplinary dental procedures. These episodes have the potential to result in acute medical and life-threatening emergencies since the beginning of the event or at a late stage in proceeding in the underdiagnosed patient. Prevention of such incidents is, therefore, the best approach via the mandatory use of precautions during all dental procedures, and in case of suspicion with no retrievable material, patient must always be submitted to a radiographic study.

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Mandibular osteoradionecrosis is a serious complication of radiotherapy that often leads to severe facial deformity, intolerable pain, fracture, sequestration of devitalized bone and fistulas. The prophylaxis of this severe complication is a major goal in modern combined tumor therapy, but once the pathology is established, conservative treatment modalities are used in almost all patients in an effort to control progression. Radical surgery should only be instituted when conservative methods fail or when severe bone and softtissue necrosis prevails. Pathologic fractures and chronic fistulae are clear indicators for radical surgical management. This paper document a case report of severe bilateral mandibular osteoradionecrosis reconstructed with two sequencial osteocutaneous fibular free flap. The authors discuss the different alternatives of treatment and the most important steps for a successful management of this challenge.

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