title: Long-term outcomes of surgical resection of the jaws in cancer patients with bisphosphonate-related osteonecrosis.
abstract: Surgical treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is controversial. Current recommendations contraindicate aggressive surgery because its results are unpredictable and may trigger disease progression. In this prospective study, we assessed the effectiveness of surgical resection of the jaws in cancer patients with BRONJ. Between June 2004 and July 2009, 30 cancer patients with refractory BRONJ underwent surgical resection of the jaws at our Units. They were followed-up weekly for the first month, at 3-month intervals up to 1 year, and at 6-month intervals up to 2 years. Panoramic radiographs and CT-scan were obtained at 3, 6, 12, 18 and 24 months. Primary outcomes were the 24-month recurrence rate of BRONJ and the 24-month mortality rate. Secondary outcomes were post-operative complications, duration of hospital stay after surgery, time to return to oral diet, and degree of oral pain. The 30 patients had a median age of 66 years and were mostly females (80%). Twenty-eight underwent a single resection and two had both jaws resected, for a total of 32 resected jaws. The cumulative recurrence rate of BRONJ in resected jaws 3.1% and 9.4% at 3 and 6 months, respectively. All the jaws with recurrent BRONJ had osteomyelitis at the margins of bone resection. The cumulative incidence of death was 3%, 12% and 16% at 12, 18 and 24 months. Surgical resection of BRONJ was highly effective, with few post-operative complications and were not associated with long-term mortality.
authors: Section of Oral and Maxillofacial Surgery, Department of Surgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. alberto.bedogni@univr.it
authors: Alberto
authors: A
authors: Bedogni
authors: Giorgia
authors: G
authors: Saia
authors: Giordana
authors: G
authors: Bettini
authors: Anita
authors: A
authors: Tronchet
authors: Andrea
authors: A
authors: Totola
authors: Giorgio
authors: G
authors: Bedogni
authors: Giuseppe
authors: G
authors: Ferronato
authors: Pier Francesco
authors: PF
authors: Nocini
authors: Stella
authors: S
authors: Blandamura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000150:complications; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced / Q000601:surgery*; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000150:complications; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates