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.