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Myoken Y, Kawamoto T, Fujita Y, Yanamoto S. Reconstruction using a facial artery musculomucosal flap technique after removal of necrotic bone in the anterior areas in medication-related osteonecrosis of the jaw: A technical note. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2023. [DOI: 10.1016/j.ajoms.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Reconstruction using a submental island flap combined with mylohyoid muscle as a reliable surgical strategy after rim mandibulectomy for the management of stage 3 medication-related osteonecrosis of the mandible. Int J Oral Maxillofac Surg 2022. [DOI: 10.1016/j.ijom.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Maeda T, Yamamoto Y, Satoh A, Hayashi T. Refinements in the reconstruction of bisphosphonate-related osteonecrosis of the jaw. JPRAS Open 2022; 35:1-5. [PMID: 36578448 PMCID: PMC9791691 DOI: 10.1016/j.jpra.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/26/2022] [Indexed: 12/02/2022] Open
Abstract
The recommended treatment strategy for stage 3 bisphosphonate-related osteonecrosis of the jaw (BRONJ) is currently rigid plate fixation without bone reconstruction. However, a recent systematic review indicated the utility of microsurgical reconstruction after resection of BRONJ. Several types of flaps have been described but their applications are controversial. Here we present a detailed reconstruction plan for obtaining better outcomes in patients with maxillary and mandibular BRONJ. Given that progressive maxillary BRONJ is often invasive to the skin, including the eyelid, leading to functional loss such as leakage of discharge and ectropion, several revision surgeries are needed to increase the volume in the defect after the free flap transfer. For progressive mandibular BRONJ, hemi-mandibulectomy to subtotal mandibulectomy with an adequate margin from the necrotic bone is necessary, followed by a well-designed fibular free flap.
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Affiliation(s)
- Taku Maeda
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo City, Hokkaido 060-8638, Japan
| | - Yuhei Yamamoto
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo City, Hokkaido 060-8638, Japan
| | - Akira Satoh
- Department of Oral Diagnosis and Medicine, Graduate School of Dental Medicine, Hokkaido University, Kita 13, Nishi 7, Kita-ku, Sapporo City, Hokkaido 060-8586, Japan
| | - Toshihiko Hayashi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Asahikawa Medical University, 2-1-1-1, Midorigaoka higashi, Asahikawa City, Hokkaido 078-8510, Japan,Corresponding author at: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Asahikawa Medical University, 2-1-1-1, Midorigaoka higashi, Asahikawa City, Hokkaido 078-8510, Japan.
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Abstract
Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a condition that is becoming more common in the everyday practice of both dental and maxillofacial surgeons. Materials and methods: This paper aims to provide a comprehensive and easy to read by clinicians presentation of comprehensive, accessible, and up-to-date data on MRONJ. The individual chapters focus on the etiology, epidemiology, diagnosis, prevention, treatment, and recurrence of MRONJ. Results and discussion: It has been observed over the years that among drugs that increase the risk of the disease, apart from bisphosphonates, angiogenesis inhibitors and anti-RANKL monoclonal antibodies should also be included. A thorough physical and subjective examination, periodic correction of dental prostheses, and an adequate preparation for even the simplest of procedures in the oral cavity area can prevent or minimize the risk of MRONJ. Conclusions: It is extremely difficult to treat once it occurs and oftentimes is a recurring problem that leads to a multitude of symptoms that gradually decrease the quality of a patient’s life.
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Mandibulectomy Reconstruction with Pectoralis Major Island Flap Associated with Primary Reconstruction Plate for Mandibular Medication-Related Osteonecrosis. CURRENT HEALTH SCIENCES JOURNAL 2021; 47:117-122. [PMID: 34211758 PMCID: PMC8200619 DOI: 10.12865/chsj.47.01.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/27/2021] [Indexed: 11/18/2022]
Abstract
A bimaxillary edentulous male patient, aged 67 years, diagnosed with prostate cancer who underwent intravenous bisphosphonates treatment (zoledronic acid) for about one year presented with pain in the anterior mandibular arch, with exposed necrotic bone, and was diagnosed with stage 2 medication-related osteonecrosis of the jaw (MRONJ). MRONJ is the development of bone necrosis in the oral cavity as an adverse reaction in patients treated with antiresorptive and antiangiogenic medication, without radiation therapy to the head and neck. This persistent bone necrosis does not always respond to standard treatments. The reconstruction technique with pectoralis major flap, at a distance, associated with the primary reconstruction plate, was an effective treatment modality for the treatment of large osteonecrosis noncompliant with conservatory treatments. Through this technique, the morpho-functionality of the jaw can be restored almost completely.
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Chien HI, Chen LW, Liu WC, Lin CT, Ho YY, Tsai WH, Yang KC. Bisphosphonate-Related Osteonecrosis of the Jaw. Ann Plast Surg 2021; 86:S78-S83. [PMID: 33346545 DOI: 10.1097/sap.0000000000002650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Antiresorptive agents for bone pain were widely used to treat patients with advanced osteoporosis, multiple myeloma, and bone metastatic cancer. In recent years, however, bisphosphonate-related osteonecrosis of the jaw (BRONJ) has been a rare but major complication of this therapy. Most patients with BRONJ undergo dental procedures during treatment with antiresorptive agents. However, BRONJ may also occur spontaneously. This study reports 13 BRONJ patient cases at Kaohsiung Veterans General Hospital, Taiwan, and their related treatments. We also compare patients with cancer with patients with osteoporosis in treatment outcomes. METHODS Thirteen symptomatic patients with BRONJ were reviewed between 1985 and 2018 at Kaohsiung Veterans General Hospital. We included patients at advanced stage who were hospitalized for infection control of osteonecrosis of the jaw and excluded asymptomatic patients at stage 0 and stage 1. Four multiple myeloma, 3 patients with bone metastatic breast cancer and 6 patients with advanced osteoporosis (average ages, 63.57 ± 14.54 years in cancer patients and 79.5 ± 9.31 years in osteoporosis patients; average drug durations, 25.86 ± 27.23 months in cancer patients and 58.33 ± 23.87 months in osteoporosis patients; average follow-up times, 22.71 ± 14.46 months in cancer patients and 28.08 ± 36.35 months in osteoporosis patients) were included. RESULTS Seven patients were defined as having stage 3 (53.8%) and 6 as having stage 2 (46.2%) medication-related osteonecrosis of the jaw, according to the American Association of Oral and Maxillofacial Surgeons classification. The complete response rate with totally healed mucosa was 61.5%. Four cancer patients received free fibular flap (FFF) reconstruction with a high complete response rate (100%). All of them had a relatively better performance status, and the average age was also younger than osteoporosis patients. CONCLUSION Free fibular flap with a high complete response rate may improve pain relief and infection control for patients with BRONJ. Younger age is seemed to be a great indicator for FFF, but poor self-care ability (Eastern Cooperative Oncology Group status >3) is not suitable for these surgical treatments.
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Affiliation(s)
- Hsin-I Chien
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung
| | | | | | | | - Yen-Yi Ho
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Wei-Hsuan Tsai
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung
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Zhou W, Feng Z, An J, Wang H, Zhang Y. Combined reconstruction plate fixation and submandibular gland translocation for the management of medication-related osteonecrosis of the mandible. Int J Oral Maxillofac Surg 2020; 49:1584-1588. [DOI: 10.1016/j.ijom.2020.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/31/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
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Vanpoecke J, Verstraete L, Smeets M, Ferri J, Nicot R, Politis C. Medication-related osteonecrosis of the jaw (MRONJ) stage III: Conservative and conservative surgical approaches versus an aggressive surgical intervention: A systematic review. J Craniomaxillofac Surg 2020; 48:435-443. [PMID: 32178949 DOI: 10.1016/j.jcms.2020.02.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/02/2020] [Accepted: 02/24/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jasper Vanpoecke
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, University of Leuven, Leuven, Belgium.
| | - Laurence Verstraete
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, University of Leuven, Leuven, Belgium.
| | - Maximiliaan Smeets
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, University of Leuven, Leuven, Belgium.
| | - Joël Ferri
- Service de Stomatologie et Chirurgie Maxillo-faciale Centre Hospitalier et Universitaire Hôpital R. Salengro, 59037, Lille Cedex, France.
| | - Romain Nicot
- Service de Stomatologie et Chirurgie Maxillo-faciale Centre Hospitalier et Universitaire Hôpital R. Salengro, 59037, Lille Cedex, France.
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, University of Leuven, Leuven, Belgium.
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Myoken Y, Fujita Y, Okamoto T. Modified Submental Island Flap for the Surgical Treatment of 4 Patients With Stage 3 Medication-Related Osteonecrosis of the Mandible. J Oral Maxillofac Surg 2020; 78:29-34. [DOI: 10.1016/j.joms.2019.08.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 10/26/2022]
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Yarom N, Shapiro CL, Peterson DE, Van Poznak CH, Bohlke K, Ruggiero SL, Migliorati CA, Khan A, Morrison A, Anderson H, Murphy BA, Alston-Johnson D, Mendes RA, Beadle BM, Jensen SB, Saunders DP. Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline. J Clin Oncol 2019; 37:2270-2290. [PMID: 31329513 DOI: 10.1200/jco.19.01186] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To provide guidance regarding best practices in the prevention and management of medication-related osteonecrosis of the jaw (MRONJ) in patients with cancer. METHODS Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. Guideline development involved a systematic review of the literature and a formal consensus process. PubMed and EMBASE were searched for studies of the prevention and management of MRONJ related to bone-modifying agents (BMAs) for oncologic indications published between January 2009 and December 2017. Results from an earlier systematic review (2003 to 2008) were also included. RESULTS The systematic review identified 132 publications, only 10 of which were randomized controlled trials. Recommendations underwent two rounds of consensus voting. RECOMMENDATIONS Currently, MRONJ is defined by (1) current or previous treatment with a BMA or angiogenic inhibitor, (2) exposed bone or bone that can be probed through an intraoral or extraoral fistula in the maxillofacial region and that has persisted for longer than 8 weeks, and (3) no history of radiation therapy to the jaws or metastatic disease to the jaws. In patients who initiate a BMA, preventive care includes comprehensive dental assessments, discussion of modifiable risk factors, and avoidance of elective dentoalveolar surgery (ie, surgery that involves the teeth or contiguous alveolar bone) during BMA treatment. It remains uncertain whether BMAs should be discontinued before dentoalveolar surgery. Staging of MRONJ should be performed by a clinician with experience in the management of MRONJ. Conservative measures comprise the initial approach to MRONJ treatment. Ongoing collaboration among the dentist, dental specialist, and oncologist is essential to optimal patient care.
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Affiliation(s)
- Noam Yarom
- Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Tel Aviv University, Tel Aviv, Israel
| | | | | | | | - Kari Bohlke
- American Society of Clinical Oncology, Alexandria, VA
| | - Salvatore L Ruggiero
- Hofstra North Shore-LIJ School of Medicine, Hempstead, NY.,Stony Brook School of Dental Medicine, Stony Brook, NY.,New York Center for Orthognathic and Maxillofacial Surgery, New York, NY
| | | | - Aliya Khan
- McMaster University, Hamilton, Ontario, Canada
| | - Archie Morrison
- Dalhousie University, Halifax, Nova Scotia, Canada.,Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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Aljohani S, Troeltzsch M, Hafner S, Kaeppler G, Mast G, Otto S. Surgical treatment of medication-related osteonecrosis of the upper jaw: Case series. Oral Dis 2018; 25:497-507. [PMID: 30325561 DOI: 10.1111/odi.12992] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 09/21/2018] [Accepted: 10/10/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The management of maxillary medication-related osteonecrosis of the jaw (MRONJ) is challenging. Therefore, identifying the proper treatment is important. This study aimed to evaluate the surgical treatment of maxillary MRONJ using single-layer closure with mucoperiosteal flap and double-layer closure with buccal fat pad flap (BFPF) and mucoperiosteal flap and to find the outcomes after rehabilitation with obturators. METHODS A retrospective analysis was conducted and included all surgically treated and followed-up maxillary MRONJ cases in a single center. Demographics and clinical data, stage of MRONJ, surgical treatment, and treatment outcome were collected. RESULTS Seventy-nine lesions were included. Removal of necrotic bone was followed by coverage with mucoperiosteal flap in 60 lesions and BFPF in 14 lesions. Seven lesions (five primarily and two following unsuccessful treatment with BFPF) underwent necrectomy and were reconstructed with obturators. Complete mucosal healing was achieved in 76.7% of the lesions covered with mucoperiosteal flap. BFPF led to complete mucosal healing in 85.7% of the lesions. No complications were observed in the defects rehabilitated with obturators. CONCLUSION Removal of necrotic bone followed by closure with mucoperiosteal flap is reliable for MRONJ treatment. BFPF is effective for closure of MRONJ-related oroantral communications (OACs).
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Affiliation(s)
- Suad Aljohani
- Department of Oral- and Maxillofacial Surgery, Ludwig-Maximilians-University, Munich, Germany.,Department of Oral Basic & Clinical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Matthias Troeltzsch
- Department of Oral- and Maxillofacial Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Sigurd Hafner
- Department of Oral- and Maxillofacial Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Gabriele Kaeppler
- Department of Oral and Maxillofacial Radiology, Clinic for Oral and Craniomaxillofacial Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Gerson Mast
- Department of Oral- and Maxillofacial Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Sven Otto
- Department of Oral- and Maxillofacial Surgery, Ludwig-Maximilians-University, Munich, Germany
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Microsurgical Reconstruction of the Jaws Using Vascularised Free Flap Technique in Patients with Medication-Related Osteonecrosis: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9858921. [PMID: 29977926 PMCID: PMC6011121 DOI: 10.1155/2018/9858921] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 04/02/2018] [Accepted: 05/09/2018] [Indexed: 11/17/2022]
Abstract
Background Osteonecrosis of the jaw (ONJ) has been reported to be associated with patients receiving primarily bisphosphonate (BP) therapies. However, lately it has been documented that other medications, such as RANK ligand inhibitor (denosumab) and antiangiogenic drug, can cause ONJ. Micro-osseous-vascular reconstruction of the jaws in patients affected by medication-related osteonecrosis of the jaw represents a viable option of treatment for patients affected by stage III of the disease. However, there are still considerable doubts about the success of this procedure in the short, medium, and long term. Material and Methods A multidatabase (PubMed/MEDLINE, EMBASE, and CENTRAL) systematic search was performed. Any type of studies considering human patients treated with antiresorptive and antiangiogenic drugs was considered. The aim of the research is to primarily understand the success rate of micro-osseous-vascular reconstruction in the short, medium, and long period of time. This review has also the goal of better understanding any perioperative and postoperative complications resulting from the use of the reconstruction techniques. Results Eighteen studies resulted eligible for the study. Fibula free flap is the most commonly utilised vascularised free flap reconstruction technique (80.76%). Ten out of eighteen studies reported no complications. Recurrence of osteonecrosis was registered in five cases (6.41%) after free flap reconstruction. The overall free flap success rate was 96.16%. Conclusions Based on the limited data available in literature (Level 4 of the Oxford Evidence-based medicine scale), micro-osseous-vascular reconstruction of the jaws represents a valid treatment in patients with bisphosphonate-related osteonecrosis at stage III of the disease. However, additional data based on a larger cohort of patients are necessary to justify this type of intervention in patient affected by MRONJ.
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Lemound J, Muecke T, Zeller AN, Lichtenstein J, Eckardt A, Gellrich NC. Nasolabial Flap Improves Healing in Medication-Related Osteonecrosis of the Jaw. J Oral Maxillofac Surg 2017; 76:877-885. [PMID: 29104029 DOI: 10.1016/j.joms.2017.09.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Medication-related osteonecrosis of the jaw (MRONJ) is an adverse side effect of antiresorptive and antiangiogenic therapeutic agents that is difficult to treat owing to its high relapse rate. The aim of the present study was to determine whether patients with MRONJ treated using decortication and a nasolabial flap compared with those who underwent decortication with mucoperiosteal flaps have better outcomes regarding stable wound closure. MATERIALS AND METHODS Two groups of patients with MRONJ and intraoral exposed bone were evaluated in a cohort clinical study retrospectively. The primary predictor variable was the treatment group. The experimental group used the nasolabial flap for wound closure, and the control group used the mucoperiosteal flap for closure. The outcome variable was successful wound closure defined as a symptomless and closed wound after at least 12 months. Other study variables included factors such as perioperative drug holiday, duration of postoperative oral antibiotic administration, and postoperative use of nasogastric feeding tubes. Cox proportional hazard regression analysis and Kaplan-Meier curves were used to determine the factors independently associated with the dependent variable. The Mann-Whitney U test and χ2 test were used for analyses regarding group-related data. RESULTS Both groups showed similar demographics. The 16 study patients receiving nasolabial flaps had a mean age of 69.9 years, and the 16 control patients receiving mucoperiosteal flaps had a mean age of 71.8 years. Both groups included 10 women and 6 men. Of the 16 patients in each group, 15 had received a bisphosphonate and 1, monoclonal antibody therapy. All evaluated patients underwent combined treatment, including decortication and intravenous antibiotics. Of the 16 patients receiving nasolabial flaps, symptomless intact wound closure was achieved in 68.8%. Of the 16 patients with mucoperiosteal closure, 18.7% achieved wound closure, with 81.2% developing a relapse of MRONJ, a statistically significant difference (P < .001). No statistically significant differences were found between the 2 groups in the demographic variables. The mean interval to relapse for the experimental and control groups was 13.6 ± 7.8 and 8.2 ± 7.9 months, respectively (P = .017). CONCLUSIONS MRONJ is a complication of antiosteoclastic treatment of mostly oncologic, palliative patients, which requires a very methodical approach to surgical treatment. A variety of different methods have been reported. The use of nasolabial flaps can be considered as a highly reliable option for coverage the bone wound with less morbidity than microvascular free flaps and better long-term results compared with mucoperiosteal flaps.
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Affiliation(s)
- Juliana Lemound
- Consultant, Department of Oral and Maxillofacial Surgery, Klinikum Darmstadt, Darmstadt, Germany.
| | - Thomas Muecke
- Head, Department of Oral and Maxillofacial Surgery, Malteser Klinikum Krefeld-Uerdingen and Duisburg Homberg, Krefeld, Germany
| | - Alexander-Nicolai Zeller
- Resident, Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Jürgen Lichtenstein
- Specialist, Clinic of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - André Eckardt
- Professor and Head, Department of Oral and Maxillofacial Surgery, Hospital Bremerhaven-Reinkenheide, Bremerhaven, Germany
| | - Nils-Claudius Gellrich
- Professor and Head, Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
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Hell BH. Reconstruction of the bony chin using sagittal split osteotomies of the remaining mandible - A new technique for a special indication: Case report. J Craniomaxillofac Surg 2017; 45:1378-1386. [PMID: 28764951 DOI: 10.1016/j.jcms.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/10/2017] [Accepted: 06/01/2017] [Indexed: 11/24/2022] Open
Abstract
There are several indications for resecting the bony chin, such as squamous cell carcinoma, sarcoma, or benign tumors of the jaw such as ameloblastoma. Several techniques for reconstruction of the bony chin, such as the use of metal plates and also revascularized free bone grafts of the iliac crest, fibula, or scapula, are common. In the case of poor vascular supply, however, alternative techniques may be necessary. In this report, a new technique is described using pedicled bone flaps from both sagittally split mandibular stumps following chin resection. These flaps were pedicled on the mylohyoid muscles and advanced to restore the continuity of the mandible. An advantage of this procedure was minimization of the soft tissue defect, making repair easier. Morbidity of the resection and reconstruction was thus reduced, and recovery of the patient was very quick.
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Affiliation(s)
- Berthold H Hell
- Department of Oral- and Maxillofacial Surgery (Head: Prof. Dr. Dr. B. Hell), Diakonie Klinikum Jung-Stilling, Wichernstraße 40. 57074, Siegen, Germany.
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El-Rabbany M, Sgro A, Lam DK, Shah PS, Azarpazhooh A. Effectiveness of treatments for medication-related osteonecrosis of the jaw: A systematic review and meta-analysis. J Am Dent Assoc 2017; 148:584-594.e2. [PMID: 28527518 DOI: 10.1016/j.adaj.2017.04.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/01/2017] [Accepted: 04/05/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND The effectiveness of management strategies used for the treatment of medication-related osteonecrosis of the jaw (MRONJ) remains poorly understood. The authors evaluated systematically the effectiveness of the various treatment modalities used for MRONJ. TYPES OF STUDIES REVIEWED The authors conducted a comprehensive search of MEDLINE, Embase, the Cochrane Library, and Scopus to identify randomized controlled trials, nonrandomized controlled trials, and prospective cohort studies to evaluate comparatively the effectiveness of management strategies for the treatment of MRONJ. The authors conducted the identification of eligible studies in duplicate and synthesized the extracted data by means of a meta-analysis, when feasible. RESULTS The authors found 13 studies with a medium-to-high risk of bias that met the inclusion criteria of this review. The authors found that, compared with medical treatment of local antimicrobials with or without systemic antimicrobials, the study investigators associated surgical treatment with higher odds of complete resolution of the condition (2 studies; 76 participants; unadjusted odds ratio, 3.55; 95% confidence interval, 1.12 to 11.19). The effectiveness of other therapies, such as bisphosphonate drug holidays, teriparatide, and hyperbaric oxygen, was uncertain. CONCLUSIONS AND PRACTICAL IMPLICATIONS On the basis of the results of an unadjusted analysis, the results of the studies that were deemed to be medium to low quality and to have medium-to-low statistical power suggested that there are higher odds of resolving MRONJ with surgical treatment compared with medical treatment. High-quality research is required for conclusive statements to be made regarding treatment strategies for management of MRONJ.
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Impact of Soft Tissue Pathophysiology in the Development and Maintenance of Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ). Dent J (Basel) 2016; 4:dj4040036. [PMID: 29563478 PMCID: PMC5806955 DOI: 10.3390/dj4040036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/03/2016] [Accepted: 10/03/2016] [Indexed: 12/30/2022] Open
Abstract
Since the first description of bisphosphonate-related osteonecrosis of the jaw (BRONJ), numerous research groups have focused on possible pathological mechanisms including the suppression of the bone turnover of the jaw, antiangiogenic effects and soft tissue toxicity. In our review we focused on summarizing the role of the soft tissues in the development and progression of BRONJ. The biological behavior of fibroblasts can be significantly influenced by bisphosphonates (BP) such as a concentration dependent reduction of cell viability. High concentrations of BP can induce apoptosis and necrosis of the cells. Comparable effects could be detected for keratinocytes. Compared to non-nitrogen containing bisphosphonates, nitrogen-containing BP have worse effects on cell biology by blocking the mevalonate pathway. Further, the cell architecture and expression levels of several genes and proteins are significantly disturbed by BP. These inhibitory effects of BP are in accordance with BP-related reduced angiogenesis and neovascularization and could underline the hypothesis that inhibition of fibroblasts and keratinocytes results in delayed wound healing and can induce and trigger BRONJ.
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