Different surgical methods for the treatment of bisphosphonate-related osteonecrosis of the jaw
10.3760/cma.j.cn114453-20190527-00167
- VernacularTitle:不同手术方法治疗双膦酸盐性颌骨坏死
- Author:
Mei TIAN
1
;
Guowen SUN
;
Danni WANG
;
Haoliang CHEN
;
Yiwei ZHAI
Author Information
1. 南京大学医学院附属口腔医院·南京市口腔医院口腔颌面外科 210008
- Keywords:
Bisphosphonate-related osteonecrosis of the jaws;
Maxilla;
Mandible;
Operation surgery;
Segmental mandibulectomy
- From:
Chinese Journal of Plastic Surgery
2020;36(5):540-545
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical effect of different surgical methods in the treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ).Methods:A total of 20 cases of BRONJ who were treated for surgical treatment from January 2013 to March 2019 were included for the retrospective analysis in this study. There were 14 males and 6 females in this study. The average age of onset was 65.4 years, including 67.4 years for males and 60.7 years for females. There were 9 patients in stage 1, 7 in stage 2, 3 in stage 3, and 1 patient with maxillary lesions in stage 2 and mandibular lesions in stage 3. For patients in stage 1 or stage 2 who had poor systemic conditions and could not tolerate general anesthesia or surgical trauma. Different surgical treatments should be performed according to the results of imaging evaluation. If completely dead bones were formed locally, sequestrectomy under local anesthesia was performed. For patients whose dead bones were not completely separated, partial jaw resection was performed. For stage 3 BRONJ patients with severe symptoms occurring in the mandible, such as the formation of intraoral and external fistulas, pathological fractures, or lesions involving the lower margin of the mandible, segmental osteotomy was usually performed when general conditions were stable.Results:Of the 20 patients, 6 cases (including 1 patient with lesions involving both maxilla and mandible) underwent sequestrectomy, 11 cases partial jaw resection and 4(including 1 patient with lesions involving both maxilla and mandible) mandibular segmental osteotomy. The patients were followed up for 1-67 months (mean 32.8 months). All the patients who underwent mandibular segmental osteotomy were recovered well and discharged. 6 patients were clinically asymptomatic after partial jawbone resection. The symptoms of the rest of the patients were alleviated, showing relieved pain, disappeared dead bone and so on, while the course of disease was significantly slowed down.Conclusions:Sequestrectomy and partial jaw resection can relieve symptoms and improve quality of life of patients, so that some patients can achieve clinical cure. Mandibular segmental osteotomy as a more effective treatment method, can be considered as the preferred treatment for stage 3 patients with lesions in the mandible and with good systemic condition.
