Surgical treatment of bisphosphonate-associated necrosis of the maxilla with concomitant sinusitis

Bisphosphonates reduce skeletal complications of bone diseases such as osteoporosis and bone metastases. During the last years, the number of patients with bisphosphonate-associated necrosis of the jaw (BP-ONJ) increased. Many authors recommend a conservative treatment approach, which does not lead to healing of the defects in most cases. Recently, a surgical approach has become more popular, and a secure wound closure seems to play an important role in the success of the surgical treatment. The aim of this retrospective study is to show intermediate-term results after surgical treatment using a multilayer technique in 12 consecutive cases with BP-ONJ of the maxilla affecting the maxillary sinus.

Materials and methods : Twelve patients with BP-ONJ of the maxilla and sinusitis were treated with necrosectomy and a multilayer wound closure technique. The patients received prolonged perioperative intravenous antibiotic treatment and were fed with a nasogastral feeding tube postoperatively. Clinical and radiological recall was carried out frequently for 10–25 months.

Results : One patient presented with a purulent sinusitis without open bone intraorally. A whitish striation was noticeable in all patients with a purulent sinusitis. All patients showed regular wound healing initially. One patient had a recurrent disease one year after the initial surgery, however, the bony fistula was closed with a thick scarred membrane, and there was no sign of a new sinusitis. After a mean observation time of 18 months, the remaining 11 patients had uneventful wound-healings without pathological findings.

Conclusion : The surgical technique used can be proposed for the treatment of BP-ONJ of the maxilla.

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Jan 20, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Surgical treatment of bisphosphonate-associated necrosis of the maxilla with concomitant sinusitis
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