title: Primary surgical therapy for osteonecrosis of the jaw secondary to bisphosphonate therapy.
abstract: 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.
authors.affiliation: Division of Oral Diagnosis and Oral and Maxillofacial Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. kademani.deepak@mayo.edu
authors.forename: Deepak
authors.initials: D
authors.lastname: Kademani
authors.forename: Sreenivas
authors.initials: S
authors.lastname: Koka
authors.forename: Martha Q
authors.initials: MQ
authors.lastname: Lacy
authors.forename: S Vincent
authors.initials: SV
authors.lastname: Rajkumar
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects* / Q000627:therapeutic use; D007571:Jaw Diseases / Q000139:chemically induced / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000379:methods*; D010020:Osteonecrosis / Q000139:chemically induced / Q000601:surgery*; D010024:Osteoporosis / Q000188:drug therapy; D000077268:Pamidronate; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D000077268:Pamidronate