title: Bisphosphonate-associated osteonecrosis of the mandible: reliable soft tissue reconstruction using a local myofascial flap.
abstract: For the treatment of bisphosphonate-associated osteonecrosis of the jaw (BP-associated ONJ), poor cure rates are reported. In many cases, repeated osseous exposition and infection may occur. The currently recommended management of affected patients is antibiotic treatment and bony decortication, which is often complicated by soft tissue deficits due to chronic infection. In severe cases osteonecrosis can be managed often only by continuity resections of the mandible. For this purpose, we developed a new surgical procedure, which allows an effective closure of difficult jaw wounds in the lateral mandible. In the last 3 years, 20 patients with BP-associated osteonecrosis of the lower jaw were treated successfully with a modified defect-covering method using a myofascial flap. A mylohyoid muscle flap was detached from mylohyoid line and used to cover the bony defect. During 19 months mean follow-up, 90% of patients were asymptomatic, the oral mucosa was intact, and no exposed bone was observed. In consequence, we are able to demonstrate that a mylohyoid muscle flap provides a reliable wound closure in the lower jaw in patients treated with BPs. Although there are still no consensual therapy guidelines for patients affected by BP-associated ONJ, the results of the presented study provide evidence for an effective surgical therapy with long-term success. Covering compromised bone with well-vascularized tissue, a muscle flap, increased healing chances by enabling and supporting the necessary nutrition and defense against opportunistic infections. This therapy concept showed a good clinical outcome.
authors.affiliation: Department of Cranio- and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. Lemound.Juliana@mh-hannover.de
authors.forename: Juliana
authors.initials: J
authors.lastname: Lemound
authors.forename: Andrè
authors.initials: A
authors.lastname: Eckardt
authors.forename: Horst
authors.initials: H
authors.lastname: Kokemüller
authors.forename: Constantin
authors.initials: C
authors.lastname: von See
authors.forename: Pit Jacob
authors.initials: PJ
authors.lastname: Voss
authors.forename: Frank
authors.initials: F
authors.lastname: Tavassol
authors.forename: Martin
authors.initials: M
authors.lastname: Rücker
authors.forename: Majeed
authors.initials: M
authors.lastname: Rana
authors.forename: Nils-Claudius
authors.initials: NC
authors.lastname: Gellrich
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000601:surgery*; D050071:Bone Density Conservation Agents / Q000009:adverse effects; D001859:Bone Neoplasms / Q000188:drug therapy / Q000556:secondary; D003646:Debridement; D004164:Diphosphonates / Q000009:adverse effects; D005205:Fascia / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects; D008297:Male; D008336:Mandibular Diseases / Q000601:surgery*; D008875:Middle Aged; D009334:Neck Muscles / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D013536:Suture Techniques; D016896:Treatment Outcome; D058106:Wound Closure Techniques; D000077211:Zoledronic Acid
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid