Surgical treatment of bisphosphonate-induced osteonecrosis of the jaws significantly reduces pain

Background and objectives : Treatment of bisphosphonate (BP)-induced osteonecrosis of the jaws (ONJ) varies from conservative to surgical and there exist no global consensus. Since 2010 we have used a systematic surgical approach. The objectives are to present the effect of surgical treatment of consecutive patients with ONJ.

Methods : Fifty patients (11 men, 39 women) were operated for ONJ. Each patient was assessed for jaw pain by VAS scale, clinical findings, imaging, and ONJ-stage before operation, 3 months (mo.) postoperative, and at last examination (last ex.) (mean 9 mo.). The patients had been treated with BP for multiple myeloma, mamma cancer, prostate cancer, or osteoporosis. BP treatment period was on average 30 months (range 3–168). Surgical procedures included superficial sequestrectomy, block resection or continuity resection. Indication for each operation type was dependent of symptoms and ONJ-stage. Differences in mean VAS score preoperative were compared to 3 mo. postoperative and at last ex. using paired T -test (SPSS).

Results : Preoperative ONJ-staging was: stage-1: n = 13, stage-2: n = 27, stage-3: n = 10. The distribution of surgical procedures was sequestrectomy ( n = 16), block resection ( n = 30), and continuity resection ( n = 4). Mean pain score decreased from 3.58 (range 0–10) preoperatively to 0.16 (range 0–3) at 3-months, and 0.14 (range 0–3) at last examination ( P < 0.0001). At final examination 44 (88%) were cured (no symptoms and no bone exposure and no radiologic signs of ONJ), 3 had ONJ stage-1, 3 had ONJ-stage-2 and none had ONJ stage-3. Thus, 47 of the 50 patients (94%) were free of symptoms at last examination.

Conclusions : Sequestrectomy, block resection and continuity resection are effective for ONJ-treatment and significantly reduces jaw pain and ONJ stage. There is a need for randomized study of surgical versus conservative treatment.

Key words: bisphosphonate; osteonecrosis; jaws; surgical treatment; cancer

Disclosures : none.

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Jan 20, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Surgical treatment of bisphosphonate-induced osteonecrosis of the jaws significantly reduces pain

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