Microsurgical Reconstruction After Bisphosphonate-Related Osteonecrosis of the Jaw

Abstract

Despite initial concerns regarding reliability of the mandibular free-flap reconstruction after BRONJ, this method seems to be a safe and feasible option in cancer patients with reasonable life expectancy, with complete BRONJ resolution and life quality improvement. Our findings confirm data previously published by other authors, without complication and with a much longer median follow-up time.

Pedicled Buccal Fat Pad Flap as a Reliable Surgical Strategy for the Treatment of Medication-Related Osteonecrosis of the Jaw

“…Although conservative treatment has been an option for MR-ONJ, painful disease states require intensive intervention. 5,6 The surgical treatment for MR-ONJ is removal of the necrotic bone and the covering bone defect using a flap. Trials using local mucosal flaps have exhibited high failure rates due to poor vascularity.…”

Pathophysiology of Osteonecrosis of the Jaws

“…Any procedures that remove soft tissue and/or expose bone, including extractions, are generally avoided when a conservative treatment plan is followed. More invasive treatment strategies may include local curettage and debridement, en bloc resection, flap advancement and resective surgery [8–10]. …”

Resection and microvascular reconstruction of bisphosphonate‐related osteonecrosis of the jaw: The role of microvascular reconstruction

“…No randomized controlled clinical trials have been performed comparing free flap reconstruction after resection in patients with BRONJ. All published studies to date have been case reports and case series (Table ) . There have been 2 systematic reviews published on the topic, the latter included cases from and added to the former .…”

“…There have been 2 systematic reviews published on the topic, the latter included cases from and added to the former . Spinelli et al documented results from an additional 8 patients with BRONJ since the recent review authored by Vercruysse et al Including the case we currently report, there have been 40 cases of stage III BRONJ treated with free flap reconstruction in the published literature. Two articles were included because they met inclusion/exclusion criteria; however, the data were not presented in a way to separate individual patient outcomes …”

“…The authors also note, however, that there have been acceptable outcomes for patients with stage II and III disease. To date, no fewer than 40 cases of free flap reconstruction in patients with stage II or III BRONJ have been documented . Since the most recent review of this literature, Spinelli et al documented similarly excellent results without complications in 8 patients with BRONJ.…”