Management of bisphosphonate-related osteonecrosis of the jaw in oncologic patients: a surgical challenge

Aim: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious oral complication of supportive cancer therapy and the best method of treatment is still unclear. The purpose of this article is to analyze the type of treatment and outcome in a large patient cohort with BRONJ.

Patients and methods: A total of 142 patients suffering from BRONJ at different sites. All patients had been treated with intravenous bisphosphonates for various oncological diseases. A descriptive analysis of all relevant patient data was performed with particular emphasis on surgical outcome.

Results: The mandible was affected in 58% of the patients. All but two patients had previous invasive dental procedures. The mean duration of bisphosphonate treatment was 37.1 months. A total of 86% of the patients were treated surgically, including sequestrectomies and mandibular resections. Soft-tissue reconstruction was achieved by local closure, myofascial flap using the mylohyoid muscle, and a vascularized fasciocutaneous flap in one patient. No bony reconstruction was performed.

Conclusion: Surgical treatment of BRONJ remains challenging. There is only limited evidence that oncologic patients with BRONJ are candidates for vascularized bone reconstruction.

Conflict of interest: None declared.

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Jan 27, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Management of bisphosphonate-related osteonecrosis of the jaw in oncologic patients: a surgical challenge
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