scholarly journals Treatment of Stage 2 Medication-Induced Osteonecrosis of the Jaw: A Case Series

2021 ◽  
Vol 18 (3) ◽  
pp. 1018
Author(s):  
Guillermo Pardo-Zamora ◽  
Yanet Martínez ◽  
Jose Antonio Moreno ◽  
Antonio J. Ortiz-Ruíz
Keyword(s):  
Bone Structure ◽  
Negative Impact ◽  
Maxillofacial Surgery ◽  
Case Series ◽  
Osteonecrosis Of The Jaw ◽  
Oral And Maxillofacial Surgery ◽  
Minimally Invasive Surgical ◽  
Therapeutic Protocols ◽  
Serious Disease ◽  
The University

Medication-induced jaw osteonecrosis (MRONJ) is a rare and serious disease with a negative impact on patients’ quality of life, whose exact cause remains unclear and which may have a multifactorial origin. Although there are different therapeutic protocols, there is still no consensus. This case series evaluated three patients diagnosed with staged 2 MRONJ treated at the University of Murcia dental clinic according to the protocols described by the Spanish Society of Oral and Maxillofacial Surgery and the American Association of Oral and Maxillofacial Surgeons. Within 12 months of the application of therapeutic protocols, the lesions were completely healed in all cases. Radiography showed slow but progressive healing with normal bone structure. Conservative treatment with antibiotics, chlorhexidine rinses and minimally invasive surgical intervention with necrotic bone resection is effective in treating stage 2 of MRONJ. In cases of refractory osteonecrosis, the application of platelet and leukocyte-rich fibrin (PRF-L) in the surgical approach improves the outcome in soft tissue healing and bone regeneration but further research is needed to confirm its effectiveness.

scholarly journals Pathologic Fractures in Bisphosphonate-Related Osteonecrosis of the Jaw—Review of the Literature and Review of Our Own Cases

2013 ◽  
Vol 6 (3) ◽  
pp. 147-154 ◽  
Author(s):  
Sven Otto ◽  
Christoph Pautke ◽  
Sigurd Hafner ◽  
Ronny Hesse ◽  
Lea Franziska Reichardt ◽  
...  
Keyword(s):  
Case Reports ◽  
Treatment Options ◽  
Maxillofacial Surgery ◽  
Case Series ◽  
Pathologic Fracture ◽  
Osteonecrosis Of The Jaw ◽  
Oral And Maxillofacial Surgery ◽  
Mandibular Fractures ◽  
Pathologic Fractures ◽  
Mandible Fractures

Background Bisphosphonates are powerful drugs used for the management of osteoporosis and metastatic bone disease to avoid skeletal-related complications. Side effects are rare but potentially serious such as the bisphosphonate-related osteonecrosis of the jaws (BRONJ). BRONJ impairs the quality of life and can even lead to pathologic fractures of the mandible. Management of BRONJ is difficult per se. If complicated with pathologic mandibular fractures in advanced stages, the treatment options are controversially discussed. This review delineates the epidemiology and pathogenesis of BRONJ to put the various modalities for the treatment of pathologic mandible fractures into perspective. Methods Various case reports and case series in the literature were reviewed. Cases were reviewed of patients suffering from pathologic fracture due to bisphosphonate-related osteonecrosis of the jaw treated in the Department of Oral and Maxillofacial Surgery (Ludwig-Maximilians-University of Munich) from 2003 to 2010. Of 140 patients suffering from BRONJ, four were identified with pathologic fracture of the mandible. Results Management of pathologic mandibular fractures in patients suffering from BRONJ is an unsolved issue. At present there is a paucity of information to establish reliable therapy guidelines. The published strategies range from conservative treatment to major bone resections with or without internal or external fixation and with or without autogenous reconstruction. There is no evidence for the superiority of a single therapeutic mode, however. Conclusion Further understanding of BRONJ is mandatory to establish a sound rationale for the treatment of associated mandibular fractures.

scholarly journals Surgical Treatment of Medication-Related Osteonecrosis of the Jaw: A Retrospective Study

2020 ◽  
Vol 17 (23) ◽  
pp. 8801
Author(s):  
Na Rae Choi ◽  
Jung Han Lee ◽  
Jin Young Park ◽  
Dae Seok Hwang
Keyword(s):  
Retrospective Study ◽  
Surgical Treatment ◽  
Treatment Outcomes ◽  
Maxillofacial Surgery ◽  
Osteonecrosis Of The Jaw ◽  
Oral And Maxillofacial Surgery ◽  
Single Institution ◽  
Patient Factors ◽  
Surgical Success ◽  
Negative Impacts

The purpose of this study was to confirm the success rate of surgical treatment of medication-related osteonecrosis of the jaw (MRONJ) in patients at a single institution (Association of Oral and Maxillofacial Surgery (AAOMS) stages 1, 2, or 3), and to identify the factors that influence treatment outcomes. As a result of analyzing the outcomes of treatment, surgical “success” was achieved in 93.97% (109) of cases, and “failure” was observed at 6.03% (7) cases. Analysis of patient factors that potentially affect treatment outcomes showed that zoledronate dose (p = 0.005) and the IV (intravenous) injection of drugs (p = 0.044) had significant negative impacts.

scholarly journals Observational Study of the Bisphosphonate-Related Osteonecrosis of Jaws

2018 ◽  
Vol 91 (2) ◽  
pp. 209-215 ◽  
Author(s):  
Andreea Elena Lungu ◽  
Madalina Anca Lazar ◽  
Andrada Tonea ◽  
Horatiu Rotaru ◽  
Rares Calin Roman ◽  
...  
Keyword(s):  
Oral Treatment ◽  
Maxillofacial Surgery ◽  
Osteonecrosis Of The Jaw ◽  
Postoperative Recovery ◽  
Oral And Maxillofacial Surgery ◽  
Necrotic Bone ◽  
Functional Rehabilitation ◽  
Maxillary Bone ◽  
Medical Background ◽  
Radiological Image

Introduction. The bisphosphonate-related osteonecrosis of the jaw was first referred to in 2003. Bisphosphonates action is focused on the osteoclasts. The drastic inhibition of the osteoclastic function is harmful for the jaws which are the only bones of the human skeleton in relative contact with the external environment. The adverse effects of the bisphosphonate-related therapy include the pathology for which they are prescribed, the atypical fractures in pathological bone.Method. The aim of this research was to analyze the risk factors and the treatment methods in case of osteonecrosis of the jaws. To achieve these goals, the author analyzed the observation sheets of the patients admitted to the Oral and Maxillofacial Surgery Clinic during the period 2010-2015. The inclusion criteria were as follows: treatment with bisphosphonates, current or previous; the lesions of the mucous gingiva of the maxillaries followed by exposed necrotic bone, older than 8 weeks, with no tendency of healing; specific radiological image showing extended osteolysis with diffuse outline or radiopacity surrounded by radio-transparence, representing the necrotic bone sequestered; no metastasis in the necrotic maxillary bone; patient with no medical background of cervical-facial radiations. The patients who met these criteria were admitted in the study after signing the informed consent. Afterwards, the information found in the notes of the observational sheet (anamnesis, general examination and the imagistic investigation, treatment, postoperative recovery, prescription, postoperative recommendations) were gathered and submitted for statistic analysisResults. Of the 20 patients in total, 13 were women and 7 men, of ages ranging from 43 to 83. The most numerous cases were registered in the seventh age decade. All patients included in the study had lesions of the gingival maxillary mucosal areas with exposure of the subjacent necrotic bone. 60% of them were under intravenous treatment with zoledronic acid (Zometa®). A single patient was under oral treatment with bisphosphonates. 19 of these 20 patients developed osteonecrosis following a dental extraction while one case was due to the instability of the mandibular mobile prosthesis. 61% of the patients included in the study developed a necrotic process in the mandibular bone, 80% of the localizations were in the posterior area. As first intention, the choice of treatment was represented by local lavages with antiseptic solutions, general antibiotics and sequestrectomy. Of these patients, a third had relapsed and needed radical surgery treatment.Conclusions. Prevention of the bisphosphonate-related osteonecrosis of the jaw represents the best method of treatment. The development of bone sequesters damages the volume of the maxillary bone as such, reducing the chances for prosthetic functional rehabilitation of the dento-maxillary system. An increase in the quality of life by oral restoration of these patients may represent a challenge.

scholarly journals Practical Guidelines for the Prevention, Diagnosis, and Treatment of Osteonecrosis of the Jaw in Patients With Cancer

2006 ◽  
Vol 2 (1) ◽  
pp. 7-14 ◽  
Author(s):  
Salvatore Ruggiero ◽  
Julie Gralow ◽  
Robert E. Marx ◽  
Ana O. Hoff ◽  
Mark M. Schubert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care Professionals ◽  
Multidisciplinary Treatment ◽  
Maxillofacial Surgery ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
Oral And Maxillofacial Surgery ◽  
Patients With Cancer ◽  
Dental Procedures ◽  
Practical Guidelines

PurposeThis article discusses osteonecrosis of the jaw (ONJ) and offers health care professionals practical guidelines and recommendations for the prevention, diagnosis, and management of ONJ in cancer patients receiving bisphosphonate treatment.MethodsA panel of experts representing oral and maxillofacial surgery, oral medicine, endocrinology, and medical oncology was convened to review the literature and clinical evidence, identify risk factors for ONJ, and develop clinical guidelines for the prevention, early diagnosis, and multidisciplinary treatment of ONJ in patients with cancer. The guidelines are based on experience and have not been evaluated within the context of controlled clinical trials.ResultsONJ is a clinical entity with many possible etiologies; historically identified risk factors include corticosteroids, chemotherapy, radiotherapy, trauma, infection, and cancer. With emerging concern for potential development of ONJ in patients receiving bisphosphonates, the panel recommends a dental examination before patients begin therapy with intravenous bisphosphonates. Dental treatments and procedures that require bone healing should be completed before initiating intravenous bisphosphonate therapy. Patients should be instructed on the importance of maintaining good oral hygiene and having regular dental assessments. For patients currently receiving bisphosphonates who require dental procedures, there is no evidence to suggest that interrupting bisphosphonate therapy will prevent or lower the risk of ONJ. Frequent clinical assessments and conservative dental management are suggested for these patients. For treatment of patients who develop ONJ, a conservative, nonsurgical approach is strongly recommended.ConclusionAn increased awareness of the potential risk of ONJ in patients receiving bisphosphonate therapy is needed. Close coordination between the treating physician and oral surgeon and/or a dental specialist is strongly recommended in making treatment decisions.

Osteonecrosis of the Jaws Secondary to Bisphosphonate Therapy: A Case Series

2008 ◽  
Vol 9 (1) ◽  
pp. 63-69 ◽  
Author(s):  
Satish K. S. Kumar ◽  
Michael C. Meru ◽  
Parish P. Sedghizadeh
Keyword(s):  
Maxillofacial Surgery ◽  
Case Series ◽  
Poor Quality ◽  
Bisphosphonate Therapy ◽  
Oral And Maxillofacial Surgery ◽  
Osteonecrosis Of The Jaws ◽  
Cancer Metastases ◽  
Dental Procedures ◽  
Southern California School ◽  
School Of Dentistry

Abstract Aim The objective of this report is to present the clinical experiences of several patients affected with osteonecrosis (ONJ) secondary to bisphosphonate (BP) therapy and to provide a discussion of the specific BPs implicated in this condition. Background ONJ secondary to BP therapy is becoming an increasingly reported complication following dental therapy. This is particularly true of surgical dental procedures such as extractions. BPs are a class of pharmaceuticals used in the treatment of numerous disorders affecting bone, including osteoporosis, cancer metastases to bone, hypercalcemia of malignancy, and multiple myeloma. Although ONJ is a more recently described phenomenon, it is an emerging problem that may be associated with significant morbidity such as oral dysfunction, impaired eating ability, pain, and compromised esthetics resulting in a poor quality of life in affected patients. Case Report This is a description of 13 patients affected with ONJ secondary to BP therapy managed at the Orofacial Pain & Oral Medicine Center, Special Patients Clinic, and Oral and Maxillofacial Surgery Clinic at the University of Southern California, School of Dentistry between October 2005 and April 2007, with a discussion of the specific BPs implicated in this condition, the clinical presentation, management, and follow-up. Summary Thorough reporting of every case of ONJ is important to help advance the understanding of this poorly understood condition. The authors’ approach to care represents a more conservative mode to management than previously described by many investigators. Citation Kumar SKS, Meru MC, Sedghizadeh PP. Osteonecrosis of the Jaws Secondary to Bisphosphonate Therapy: A Case Series. J Contemp Dent Pract 2008 January;(9)1:063-069.

Transconjunctival Approach Using Lateral Skin Extension for Reconstruction of Orbit Zygomatic Complex Fractures: Technique Description and a Case Series Analysis

2020 ◽  
pp. 194338752097008
Author(s):  
Salvador Valladares Pérez ◽  
Diego Bustamante Correa ◽  
Carlos Cortez Fuentes ◽  
Felipe Astorga Mori ◽  
Gerson Sepúlveda Troncoso ◽  
...  
Keyword(s):  
Maxillofacial Surgery ◽  
Case Series ◽  
Lateral Wall ◽  
Orbital Floor ◽  
Oral And Maxillofacial Surgery ◽  
Transconjunctival Approach ◽  
Unique Approach ◽  
Orbital Rim ◽  
Infraorbital Rim

Study Design: A descriptive-observational study of a series case report of patients diagnosed with orbito-zygomatic complex (OZMC) fracture with lateral wall involvement, was conducted. All patients were assessed in the Oral and Maxillofacial Surgery Service at Hospital El Carmen, Maipu, Santiago, Chile. Objective: The purpose of this study was to evaluate a single-institution experience with the transconjunctival approach to the orbit, utilizing a lateral skin extension as unique approach to access to fronto-zygomatic suture, infraorbital rim and/or orbital floor. Method: The authors identified 41 patients with OZMC fractures who underwent to surgical treatment over a 45 months period. Among this group, 21 patients needed fixation with osteosynthesis of the frontozygomatic suture, and 16 of whom were treated with the approach being studied. The authors assessed scleral exposure, eyelid position changes, ectropion, and entropion as outcome measures, and reported satisfactory outcomes at a minimum of 9 months follow-up. Conclusions: This study concludes that in our experience, the transconjunctival approach utilizing a lateral skin extension allows a direct, easy, and quick access to the entire infra orbital rim, orbital floor, fronto-zygomatic suture and lateral wall of the orbit, up to spheno-zygomatic suture, with low associated morbidity and complications.

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