Elsevier

Mayo Clinic Proceedings

Volume 81, Issue 8, August 2006, Pages 1100-1103
Mayo Clinic Proceedings

CASE REPORT
Primary Surgical Therapy for Osteonecrosis of the Jaw Secondary to Bisphosphonate Therapy

https://doi.org/10.4065/81.8.1100Get rights and content

Bisphosphonate chemotherapy is commonly used in the treatment of bone diseases such as osteoporosis, Paget disease, and multiple myeloma and to limit bone pain and hypercalcemia associated with malignant metastatic bone lesions. The introduction of bisphosphonate therapy has improved the quality of life in a vast majority of patients, showing clear medical efficacy. However, since 2003 a growing number of reports have described necrotic bone lesions (osteonecrosis of the jaw [ONJ]) affecting maxillofacial bones in patients who have received chemotherapy with intravenous bisphosphonate therapy. Unfortunately, the development of ONJ has been refractory to conventional treatment modalities. Several treatment options have been proposed for ONJ, most of which focus primarily on conservative management with local irrigation and empirical long-term antibiotic therapy. However, results of treatment have been associated with high failure rates, progression of disease, and continued decline in patients' quality of life. We describe 2 patients in whom primary surgical salvage was performed successfully for ONJ. Our experience indicates that with appropriate technique, primary surgical treatment may offer benefit to selected patients with ONJ.

Section snippets

Case 1

A 73-year-old man was referred from the hematology service at the Mayo Clinic in Rochester, Minn, to the Division of Oral and Maxillofacial Surgery for evaluation of bone exposure and pain in the right posterior mandibular alveolus. The patient's primary disease process was multiple myeloma, for which he had undergone stem cell transplantation in March 2003 and subsequent systemic BPT with zoledronate (Zometa, Novartis, East Hanover, NJ). In March 2005, he consulted his local general dental

DISCUSSION

Considerable speculation has centered on the mechanisms of ONJ development in individuals receiving BPT. Three principal theories of etiology have been offered: (1) bisphosphonates inhibit osteoclast activity, thereby reducing the rate of bone turnover, which results in compromised bone wound healing; (2) bone healing is compromised, but the lack of primary mucosal closure over areas of exposed bone is the key factor in the development of ONJ; and (3) bone healing is compromised, but factors

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