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Surgical treatment of bisphosphonate-associated osteonecrosis of the mandible: Report of two cases

Year 2015, , 61 - 64, 10.05.2015
https://doi.org/10.5799/ahinjs.01.2015.01.0487

Abstract

Bisphosphonates are used to reduce skeletal-related events in patients with bone-consuming diseases, such as osteoporosis and bone metastases. Bisphosphonaterelated osteonecrosis of the jaw (BRONJ) is becoming increasingly common with increasing use of bisphosphonates. We present two cases of BRONJ in a 64-year-old female and a 56-year-old female who were admitted to our department with complaints of purulent discharge and pain of the lower jaw. Both patients had been taking bisphosphonate and were diagnosed with jaw osteonecrosis, which can occur due to long-term use of bisphosphonate. The patients underwent medical treatment, including chlorhexidine rinses and antibiotics. Bone debridement was then performed under local anaesthesia. Both patients recovered well. There are many protocols, guidelines and suggestions on the management of BRONJ. For most patients, a conservative approach with minimal local intervention, if necessary, is appropriate, with extensive debridement of necrotic bone when this fails. In a small number of cases, radical resection of bone and reconstruction may be required. J Clin Exp Invest 2015; 6 (1): 61-64 Key words: Osteonecrosis, Bisphosphonate, jaw

References

  • Pit JV, Joel JO, Alice KM. Surgical treatment of bisphosphonate-associated
  • osteonecrosis of the jaw. J Cranio
  • Maxill Surg 2012;40:719-725.
  • Rathan MS, Gary MM. Bisphosphonate induced osteonecrosis
  • of the mandible. Eur J Radiology Extra
  • ;66:9–11.
  • Tomoaki S, Mutsumi M, Ryouji T. Bisphosphonate-related
  • osteonecrosis of the jaw successfully treated with surgical
  • resection and its histopathological features: A longterm
  • follow-up report. J Oral Maxill Surg Pathol Med
  • ;275:4-8.
  • Robert E. M. Pamidronate (Aredia) and zoledronate (Zometa)
  • induced avascular necrosis of the jaws: a growing
  • epidemic. J Oral Maxill Surg 2003;6:1115-1118.
  • Robert EM, Yoh S, Michel F, Vishtasb B. Bisphosphonate-induced
  • exposed bone (osteonecrosis/osteopetrosis)
  • of the jaws: risk factors, recognition, prevention,
  • and treatment: J Oral Maxill Surg 2005;63:1567–1575.
  • Cesar AM. Bisphosphanates and oral cavity avascular
  • bone necrosis: J Clin Oncol 2003;21:4253-4254.
  • American Association of Oral and Maxillofacial Surgeons.
  • Position paperon bisphosphonate-related osteonecrosis
  • of the jaws; 2006. Available at: http://www.aaoms.
  • org/docs/position papers/osteonecrosis.pdf.
  • Cesar AM, Michael AS, Linda SE. Bisphosphonateassociated
  • osteonecrosis: a long-term complication of
  • bisphosphonate treatment: Lancet Oncol 2006;7:508–
  • -
  • Ian RR. Osteonecrosis of the jaw — Who gets it, and
  • why? Bone 2009;44:4–10.
  • PF Nocini, G Saia, G Bettini. Vascularized fibula flap reconstruction
  • of the mandible in bisphosphonate-related
  • osteonecrosis. The J Cancer Surg 2009;35:373-379.
  • Lerman MA, Xie W, Treister NS. Conservative management
  • of bisphosphonate-related osteonecrosis of
  • the jaws Staging and treatment outcomes. Oral Oncol
  • ;49:977–983.
  • Curi MM, Cossolin GS, Koga DH. Bisphosphonate-related
  • osteonecrosis of the jaws—An initial case series
  • report of treatment combining partial bone resection
  • and autologous platelet-rich plasma. J Oral Maxill Surg
  • ;69:2465-2472.
  • Lee CY, David T, Nishime M. Use of platelet- rich plasma
  • in the management of oral bisphosphonate-associated
  • osteonecrosis of the jaw: A report of 2 cases. J Oral Implantol
  • ;32:371-382.
  • Pripatnanont P, Nuntanaranont T, Vongvatcharanon S,
  • et al. The primacy of platelet-rich fibrin on bone regeneration
  • of various grafts in rabbit’s calvarial defects. J
  • Cranio Maxill Surg 2013;41:191-200.
  • Dhoan DMJ, Choukroun AD, et al. Platelet-rich fibrin
  • (PRF): A second-generation platelet concentrate. Part
  • III: Leucocyte activation: A new feature for platelet concentrate?
  • Oral Surgery Oral Med Oral Pathol Oral Radiol
  • Endod 2006;101:51-55.
  • Dhoan DMJ, Ehrenfest GM, de Peppo P, et al. Slow
  • release of growth factors and thrombospondin-1 in
  • Choukroun’s platelet-rich fibrin (PRF): A gold standard
  • to achieve for all surgical platelet concentrates technologies.
  • Growth Factors 2009;27:63-69.
  • Lin JH, Russell G, Gertz B. Pharmacokinetics of alendronate:
  • an overview. Int J Clin Pract Suppl 1999;101:18–
  • -
  • Agrillo A, Lingari C, Filiaci F, et al. Ozone Therapy in the
  • Treatment of Avascular Bisphosphonate-Related Jaw
  • Osteonecrosis. J Craniofac Surg 2007;18:1071-1075.
  • Marx RE. Oral and Intravenous Bisphosphonateslnduced
  • Osteonecrosis of the Jaws: History, etiology,
  • prevention and treatment. Hanover Park: Quintessence
  • Books. 2006.

Mandibulada bifosfonat kullanımı sonucunda oluşan osteonekrozun cerrahi tedavisi: iki vaka raporu

Year 2015, , 61 - 64, 10.05.2015
https://doi.org/10.5799/ahinjs.01.2015.01.0487

Abstract

Bifosfonatlar osteoporoz ve kemik metastazı gibi hastalıklardaki kemik yıkımını azaltmaktadır. Artan bifosfonat kullanımıyla birlikte çenelerde görülen bifosfonatla ilişkili osteonekrozda yaygınlaşmaktadır. Kliniğimize alt çenede püy akıntısı ve ağrı şikayeti ile başvuran 64 ve 56 yaşında iki bayan hastanın bifosfonat kullanımıyla ilişkili osteonekroz vakalarını sunuyoruz. Her iki vakada uzun dönem bifosfonat kullanımına bağlı osteonekroz teşhisi konuldu. Tıbbi ve cerrahi tedavi planlaması yapıldı. Hastalara Klorheksidin irrigasyonu ve antibiyotik reçete edildi. Daha sonra lokal anestezi altında kemik debridmanı yapıldı. Her iki hastada çok iyi iyileşme görüldü. Bifosfonatla ilgili osteonekroz tedavisi için önerilen çok sayıda protokol bulunmaktadır. Çoğu hastada konservatif bir yaklaşım olarak nekrotik kemiğin geniş debridmanı ve küçük lokal girişimler yeterlidir ancak çok az vakada bu girişimler başarısız olursa radikal olarak kemiği rezeke etmek gerekmektedir

References

  • Pit JV, Joel JO, Alice KM. Surgical treatment of bisphosphonate-associated
  • osteonecrosis of the jaw. J Cranio
  • Maxill Surg 2012;40:719-725.
  • Rathan MS, Gary MM. Bisphosphonate induced osteonecrosis
  • of the mandible. Eur J Radiology Extra
  • ;66:9–11.
  • Tomoaki S, Mutsumi M, Ryouji T. Bisphosphonate-related
  • osteonecrosis of the jaw successfully treated with surgical
  • resection and its histopathological features: A longterm
  • follow-up report. J Oral Maxill Surg Pathol Med
  • ;275:4-8.
  • Robert E. M. Pamidronate (Aredia) and zoledronate (Zometa)
  • induced avascular necrosis of the jaws: a growing
  • epidemic. J Oral Maxill Surg 2003;6:1115-1118.
  • Robert EM, Yoh S, Michel F, Vishtasb B. Bisphosphonate-induced
  • exposed bone (osteonecrosis/osteopetrosis)
  • of the jaws: risk factors, recognition, prevention,
  • and treatment: J Oral Maxill Surg 2005;63:1567–1575.
  • Cesar AM. Bisphosphanates and oral cavity avascular
  • bone necrosis: J Clin Oncol 2003;21:4253-4254.
  • American Association of Oral and Maxillofacial Surgeons.
  • Position paperon bisphosphonate-related osteonecrosis
  • of the jaws; 2006. Available at: http://www.aaoms.
  • org/docs/position papers/osteonecrosis.pdf.
  • Cesar AM, Michael AS, Linda SE. Bisphosphonateassociated
  • osteonecrosis: a long-term complication of
  • bisphosphonate treatment: Lancet Oncol 2006;7:508–
  • -
  • Ian RR. Osteonecrosis of the jaw — Who gets it, and
  • why? Bone 2009;44:4–10.
  • PF Nocini, G Saia, G Bettini. Vascularized fibula flap reconstruction
  • of the mandible in bisphosphonate-related
  • osteonecrosis. The J Cancer Surg 2009;35:373-379.
  • Lerman MA, Xie W, Treister NS. Conservative management
  • of bisphosphonate-related osteonecrosis of
  • the jaws Staging and treatment outcomes. Oral Oncol
  • ;49:977–983.
  • Curi MM, Cossolin GS, Koga DH. Bisphosphonate-related
  • osteonecrosis of the jaws—An initial case series
  • report of treatment combining partial bone resection
  • and autologous platelet-rich plasma. J Oral Maxill Surg
  • ;69:2465-2472.
  • Lee CY, David T, Nishime M. Use of platelet- rich plasma
  • in the management of oral bisphosphonate-associated
  • osteonecrosis of the jaw: A report of 2 cases. J Oral Implantol
  • ;32:371-382.
  • Pripatnanont P, Nuntanaranont T, Vongvatcharanon S,
  • et al. The primacy of platelet-rich fibrin on bone regeneration
  • of various grafts in rabbit’s calvarial defects. J
  • Cranio Maxill Surg 2013;41:191-200.
  • Dhoan DMJ, Choukroun AD, et al. Platelet-rich fibrin
  • (PRF): A second-generation platelet concentrate. Part
  • III: Leucocyte activation: A new feature for platelet concentrate?
  • Oral Surgery Oral Med Oral Pathol Oral Radiol
  • Endod 2006;101:51-55.
  • Dhoan DMJ, Ehrenfest GM, de Peppo P, et al. Slow
  • release of growth factors and thrombospondin-1 in
  • Choukroun’s platelet-rich fibrin (PRF): A gold standard
  • to achieve for all surgical platelet concentrates technologies.
  • Growth Factors 2009;27:63-69.
  • Lin JH, Russell G, Gertz B. Pharmacokinetics of alendronate:
  • an overview. Int J Clin Pract Suppl 1999;101:18–
  • -
  • Agrillo A, Lingari C, Filiaci F, et al. Ozone Therapy in the
  • Treatment of Avascular Bisphosphonate-Related Jaw
  • Osteonecrosis. J Craniofac Surg 2007;18:1071-1075.
  • Marx RE. Oral and Intravenous Bisphosphonateslnduced
  • Osteonecrosis of the Jaws: History, etiology,
  • prevention and treatment. Hanover Park: Quintessence
  • Books. 2006.
There are 70 citations in total.

Details

Primary Language English
Journal Section Case Report
Authors

İzzet Acikan This is me

Necat Aslan This is me

Halil Durmuş This is me

Yusuf Atalay This is me

Serhat Atılgan This is me

Ferhan Yaman This is me

Publication Date May 10, 2015
Published in Issue Year 2015

Cite

APA Acikan, İ., Aslan, N., Durmuş, H., Atalay, Y., et al. (2015). Surgical treatment of bisphosphonate-associated osteonecrosis of the mandible: Report of two cases. Journal of Clinical and Experimental Investigations, 6(1), 61-64. https://doi.org/10.5799/ahinjs.01.2015.01.0487
AMA Acikan İ, Aslan N, Durmuş H, Atalay Y, Atılgan S, Yaman F. Surgical treatment of bisphosphonate-associated osteonecrosis of the mandible: Report of two cases. J Clin Exp Invest. May 2015;6(1):61-64. doi:10.5799/ahinjs.01.2015.01.0487
Chicago Acikan, İzzet, Necat Aslan, Halil Durmuş, Yusuf Atalay, Serhat Atılgan, and Ferhan Yaman. “Surgical Treatment of Bisphosphonate-Associated Osteonecrosis of the Mandible: Report of Two Cases”. Journal of Clinical and Experimental Investigations 6, no. 1 (May 2015): 61-64. https://doi.org/10.5799/ahinjs.01.2015.01.0487.
EndNote Acikan İ, Aslan N, Durmuş H, Atalay Y, Atılgan S, Yaman F (May 1, 2015) Surgical treatment of bisphosphonate-associated osteonecrosis of the mandible: Report of two cases. Journal of Clinical and Experimental Investigations 6 1 61–64.
IEEE İ. Acikan, N. Aslan, H. Durmuş, Y. Atalay, S. Atılgan, and F. Yaman, “Surgical treatment of bisphosphonate-associated osteonecrosis of the mandible: Report of two cases”, J Clin Exp Invest, vol. 6, no. 1, pp. 61–64, 2015, doi: 10.5799/ahinjs.01.2015.01.0487.
ISNAD Acikan, İzzet et al. “Surgical Treatment of Bisphosphonate-Associated Osteonecrosis of the Mandible: Report of Two Cases”. Journal of Clinical and Experimental Investigations 6/1 (May 2015), 61-64. https://doi.org/10.5799/ahinjs.01.2015.01.0487.
JAMA Acikan İ, Aslan N, Durmuş H, Atalay Y, Atılgan S, Yaman F. Surgical treatment of bisphosphonate-associated osteonecrosis of the mandible: Report of two cases. J Clin Exp Invest. 2015;6:61–64.
MLA Acikan, İzzet et al. “Surgical Treatment of Bisphosphonate-Associated Osteonecrosis of the Mandible: Report of Two Cases”. Journal of Clinical and Experimental Investigations, vol. 6, no. 1, 2015, pp. 61-64, doi:10.5799/ahinjs.01.2015.01.0487.
Vancouver Acikan İ, Aslan N, Durmuş H, Atalay Y, Atılgan S, Yaman F. Surgical treatment of bisphosphonate-associated osteonecrosis of the mandible: Report of two cases. J Clin Exp Invest. 2015;6(1):61-4.