Bisphosphonate-induced necrosis of the jaws: a reconstructive nightmare.
OBJECTIVE
Bisphosphonates are used for the management of metastatic bone disease, prevention and treatment of osteoporosis and Paget's disease of bone. An increasing number of reports have associated the use of bisphosphonates with the occurrence of osteoradionecrosis of the jaw. The purpose of this review is to summarize the recent literature in this area, specifically focusing on its management.


RESULTS
Osteoradionecrosis of the jaw mostly results from the use of intravenous bisphosphonates for metastatic bone disease and multiple myeloma; cases from oral treatment for osteoporosis and Paget's disease have also been reported. It mostly affects the posterior maxilla, followed by the posterior mandible. In more than half of the affected patients, there has been preceding dental trauma or procedure. Many treatment modalities have been attempted in order to limit disease progression. Conservative management with antibiotic therapy and mouthwashes seems to be most beneficial. Surgery should be reserved for refractory and symptomatic cases.


CONCLUSIONS
It is important for the reconstructive head and neck surgeon to recognize the clinical presentation of bisphosphonate-induced osteoradionecrosis of the jaw and the role of conservative management in consistently achieving good results.
Gevorgyan
Artur
A
Department of Otolaryngology - Head and Neck Surgery, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Enepekides
Danny J
DJ
D050071:Bone Density Conservation Agents / Q000627:therapeutic use / Q000633:toxicity*; D001859:Bone Neoplasms / Q000188:drug therapy / Q000556:secondary*; D004164:Diphosphonates / Q000627:therapeutic use / Q000633:toxicity*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007571:Jaw Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D010020:Osteonecrosis / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D010024:Osteoporosis / Q000188:drug therapy*; D010025:Osteoradionecrosis / Q000175:diagnosis; D012307:Risk Factors
D050071:Bone Density Conservation Agents; D004164:Diphosphonates