Surgical management of bisphosphonate-related osteonecrosis of the jaw stages II and III

Bodem, Jens; Schaal, Carolin; Kargus, Steffen; Saure, Daniel; Mertens, Christian; Engel, Michael; Hoffmann, Jürgen; Freudlsperger, Christian

doi:10.1016/j.oooo.2015.10.033

Cited by 53 publications

(73 citation statements)

References 31 publications

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“…The most common antibiotic was a combination of penicillin-based antibiotics (ampicillin or amoxicillin) and 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 5 β-lactamase inhibitor (sulbactam or clavulanate) that was used in nine out of the17 studies (52.9%) [4][5][6][7][8][9][10][11][12]. The reported doses of ampicillin/sulbactam were 4.5-9 g/day [5,6]. The durations were 1 day preoperatively and 5-14 days postoperatively [4,6,7,9,10].…”

Section: Literature Reviewmentioning

confidence: 99%

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A literature review of perioperative antibiotic administration in surgery for medication-related osteonecrosis of the jaw

Akashi

Kusumoto

Takeda

et al. 2018

Oral Maxillofac Surg

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Section: Literature Reviewmentioning

confidence: 99%

“…The reported doses of ampicillin/sulbactam were 4.5-9 g/day [5,6]. The durations were 1 day preoperatively and 5-14 days postoperatively [4,6,7,9,10]. The second most common regime was penicillin or amoxicillin with metronidazole [13-15].…”

Section: Literature Reviewmentioning

confidence: 99%

A literature review of perioperative antibiotic administration in surgery for medication-related osteonecrosis of the jaw

Akashi

Kusumoto

Takeda

et al. 2018

Oral Maxillofac Surg

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“…It is widely accepted that early intervention reduces the risk of recurrence (Table 5). In selected cases, clinical benefit can be achieved with surgery in a shorter mean duration compared to conservative treatment, (Bodem et al, 2016;Lee, Hsiao, & Chen, 2014) especially when extensive and not conservative surgery is performed (Rupel et al, 2014;Stockmann et al, 2014). However, in cases with extended areas of necrotic bone surgical resection can confer symptom relief and in some cases definitive cure.…”

Section: Surgical Management Of Onjmentioning

confidence: 99%

“…However, in cases with extended areas of necrotic bone surgical resection can confer symptom relief and in some cases definitive cure. In selected cases, clinical benefit can be achieved with surgery in a shorter mean duration compared to conservative treatment, (Bodem et al, 2016;Lee, Hsiao, & Chen, 2014) especially when extensive and not conservative surgery is performed (Rupel et al, 2014;Stockmann et al, 2014).…”

Section: Surgical Management Of Onjmentioning

confidence: 99%

Antiresorptive treatment-associated ONJ

Eleutherakis‐Papaiakovou

Bamias

2017

Eur J Cancer Care

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Osteonecrosis of the jaw (ONJ) is a severe complication of therapy with antiresorptive agents (e.g. bisphosphonates and denosumab), which are used to manage bone metastases from cancer, to reduce the incidence of skeletal-related events. Available data indicate that 0-27, 5% of patients exposed to antiresorptive agents may develop ONJ, depending on the number of infusions and the duration of therapy. Besides antiresorptive therapy, a number of risk factors for osteonecrosis have been identified. Oral surgical procedures, tooth extractions and infection to the jawbones are considered the main risk factors for developing ONJ, when receiving antiresorptive therapy. However, a growing number of patients develop ONJ without apparent risk factors, raising concern for other predisposing factors. Jaw bone necrosis may be irreversible, resulting in a chronic disease with negative impact on the quality of patients' lives. The role of risk reduction strategies like meticulous dental screening and optimal oral hygiene is fundamental for preventing development of ONJ. ONJ is usually treated conservatively to relieve the symptoms and manage jaw bone necrosis. In certain cases, surgical intervention is required. Future research should emphasize individual predisposition to ONJ, more effective preventive measures and more efficient therapeutic procedures.

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“…However, some stages 1 and 2 cases may not resolve and instead gradually worsen. It was recently reported that surgical therapy has a higher cure rate than conservative therapy for MRONJ at stages 2 and 3 [12][13][14][15] . In this study, we report two cases of stage 2 MRONJ in which necrosis spread to the skull base despite conservative treatment, resulting in abducens nerve paralysis in one patient and hydrocephalus in the second.…”

Section: Introductionmentioning

confidence: 99%

Two cases of medication‐related osteonecrosis of the jaw with extension to the cranial base

et al. 2019

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There is no established treatment for medication-related osteonecrosis of the jaw (MRONJ). Advanced MRONJ of the maxilla dose not cure with conservative treatment, and progression may cause neurological symptoms. We herein report two cases in which MRONJ of the maxilla spread to the skull base despite conservative treatment, causing abducens paralysis in one case and hydrocephalus in the second. Case 1: A 50-year-old woman who received denosumab for 2 years for multiple bone metastases of breast cancer developed MRONJ in the left maxilla after tooth extraction. MRONJ of the maxillae can progress to the skull and may cause neurological symptoms. Abducens paralysis developed for MRONJ. Magnetic resonance images revealed narrowing of the internal carotid artery and necrosis of the sphenoid bone and clivus. Sequestrectomy was performed. Two weeks after surgery, abducens paralysis resolved. Magnetic resonance imaging 3 months after surgery showed improvement of internal carotid artery narrowing. Case 2: A 73year-old woman who received zoledronic acid for 2 years for multiple bone metastases of breast cancer developed MRONJ in the left maxilla that spread broadly despite conservative treatment. Sequestrectomy was planned, but the patient developed altered consciousness and a stiff neck; ventricular enlargement was observed on magnetic resonance images of the brain. We diagnosed hydrocephalus resulting from bacterial meningitis caused by MRONJ; ventricular drainage was performed. After drainage followed by 2 weeks of antibiotics, the sequestrum was removed. These cases suggest that some patients with maxillary MRONJ might not respond to conservative therapy and the need for early surgical intervention should be considered in order to reduce the risk of necrosis progressing and the associated infection spreading to the base of skull.Oral Surgery 13 (2020) 147--156.

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Surgical management of bisphosphonate-related osteonecrosis of the jaw stages II and III

Cited by 53 publications

References 31 publications

A literature review of perioperative antibiotic administration in surgery for medication-related osteonecrosis of the jaw

A literature review of perioperative antibiotic administration in surgery for medication-related osteonecrosis of the jaw

Antiresorptive treatment-associated ONJ

Two cases of medication‐related osteonecrosis of the jaw with extension to the cranial base

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