title: The role of inferior alveolar nerve involvement in bisphosphonate-related osteonecrosis of the jaw.
abstract: OBJECTIVE
  Hypesthesia or anesthesia of the lower lip (Vincent's symptom) is a common sign in patients with osteomyelitis of the mandible, especially in severe cases.
  
  
  METHODS
  We observed an involvement of the inferior alveolar nerve in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ). Surprisingly, we found Vincent's symptom also in patients with limited and early stages of BRONJ.
  
  
  RESULTS
  These patients were successfully treated by surgical removal of the necrotic bone combined with preoperative and postoperative administration of antibiotics. We report on the occurrence and management of an involvement of the inferior alveolar nerve in patients with BRONJ and discuss possible causes.
  
  
  CONCLUSIONS
  We conclude that impairment of inferior alveolar nerve function can be an important early symptom or even the presenting symptom of BRONJ that is also easily detectable by bisphosphonate-prescribing physicians. Concerning the management of BRONJ, we conclude that surgical removal of necrotic bone combined with antibiotics is an adequate treatment in patients with osteonecrosis of the jaw.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University, Munich, Germany. Sven.Otto@med.uni-muenchen.de
authors.forename: Sven
authors.initials: S
authors.lastname: Otto
authors.forename: Sigurd
authors.initials: S
authors.lastname: Hafner
authors.forename: Knut A
authors.initials: KA
authors.lastname: Grötz
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000009:adverse effects; D004164:Diphosphonates / Q000009:adverse effects; D005260:Female; D005892:Gingivitis, Necrotizing Ulcerative / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects; D008297:Male; D008336:Mandibular Diseases / Q000139:chemically induced / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D008340:Mandibular Nerve / Q000503:physiopathology*; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D020886:Somatosensory Disorders / Q000209:etiology*; D000077211:Zoledronic Acid
chemical_list: D000900:Anti-Bacterial Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid