title: Bisphosphonate-associated osteonecrosis of the jaws: the limits of a conservative approach.
abstract: BACKGROUND
  An increasing number of cases of osteonecrosis of the jaws (ONJ) in patients treated with bisphosphonates has been reported in the literature. ONJ significantly affects the patients' quality of life and its management is still extremely difficult.
  
  
  METHODS
  A woman with ONJ secondary to therapy with zoledronic acid came to our attention for recurrent oral infections and orocutaneous fistula unresponsive to antibiotic therapy combined with minor surgical debridements. The patient underwent major surgery to remove the fistula and clean the necrotic bone and soft tissues; a lobed skin platysma flap was used to close the defect. The treatment outcome was good.
  
  
  CONCLUSIONS
  When ONJ fails to respond to antibiotic therapy and surgical debridements, a more invasive surgical approach may be necessary to guarantee a better quality of life for the patient.
authors.affiliation: Institute of Otorhinolaringology, Hospital of Cattinara, Strada di Fiume 447, Trieste, Italy. tirellig@units.it
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Tirelli
authors.forename: Matteo
authors.initials: M
authors.lastname: Biasotto
authors.forename: Silvia
authors.initials: S
authors.lastname: Chiandussi
authors.forename: Franca
authors.initials: F
authors.lastname: Dore
authors.forename: Elena
authors.initials: E
authors.lastname: De Nardi
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Lenarda
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects*; D007571:Jaw Diseases / Q000139:chemically induced / Q000628:therapy; D010020:Osteonecrosis / Q000139:chemically induced* / Q000628:therapy; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid