Osteotomy and primary wound closure in bisphosphonate-associated osteonecrosis of the jaw: a prospective clinical study with 12 months follow-up.
OBJECTIVE
This is a prospective clinical study aimed at assessing the success rate of osteotomy and primary wound closure in patients with bisphosphonate-associated osteonecrosis of the jaw (BONJ).


METHODS
Fifty patients who had received bisphosphonates intravenously and subsequently suffered from BONJ were included in the study. All patients underwent osteotomy of the affected jaw bone region and primary wound closure under general anaesthesia. They were followed up bimonthly for a period of 12 months.


RESULTS
Macroscopically altered bone could be completely removed in all cases. In two patients with plasmocytoma, major bleeding occurred postoperatively that required monitoring in an intensive care unit. In two cases, recurrence of BONJ was diagnosed during the first 2 months. In three patients, recurrence appeared between the fourth and the sixth month. In these cases, an additional osteotomy had to be performed. Six patients died during the follow-up period. In the remaining 39 patients, no signs of recurrence could be detected during the follow-up of 12 months. The success rate of the surviving patients was 89% after 1 year.


CONCLUSIONS
Due to the high success rate of osteotomy and primary wound closure, it should be checked for every patient suffering from BONJ if osteotomy is a viable treatment option.
Stockmann
Philipp
P
Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nuremberg, Glückstrasse 11, 91054 Erlangen, Germany. philipp.stockmann@uk-erlangen.de
Vairaktaris
Eleftherios
E
Wehrhan
Falk
F
Seiss
Martin
M
Schwarz
Stephan
S
Spriewald
Bernd
B
Neukam
Friedrich-Wilhelm
FW
Nkenke
Emeka
E
D000368:Aged; D000369:Aged, 80 and over; 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; D007571:Jaw Diseases / Q000139:chemically induced / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D010954:Plasmacytoma / Q000150:complications; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D013536:Suture Techniques; D016896:Treatment Outcome
D050071:Bone Density Conservation Agents; D004164:Diphosphonates