title: Histology of the Oral Mucosa in Patients With BRONJ at III Stage: A Microscopic Study Proves the Unsuitability of Local Mucosal Flaps.
abstract: BACKGROUND
  Bisphosphonate Osteonecrosis of the Jaw (BRONJ) is a newly recognized condition reported in patients treated with aminobisphosphonates (BF). BRONJ is defined as the presence of exposed necrotic alveolar bone that does not resolve over a period of 8 weeks in a patient taking bisphosphonates who has not had radiotherapy to the jaw. Treatment protocols have been outlined, but trials and outcomes of treatment and long-term follow-up data are not yet available. In 2004 an expert panel outlined recommendations for the management of bisphosphonate-associated osteonecrosis of the jaws. Through the histological study of the oral mucosa over the bone necrosis and around the osteonecrosis area in 8 patients affected by BRONJ at III stage, the authors highlight the inappropriateness of the local mucosal flaps to cover the losses of substance of the jaw, BF-related.
  
  
  METHODS
  Mucosa tissue was taken from 8 patients, affected by BRONJ, III stage. The samples taken from the mucosa around and over the osteonecrosis area were fixed with formalin and an ematossilina-eosin dichromatic coloring was carried out.
  
  
  RESULTS
  The samples of mucosa showed pathognomonic signs of cell suffering that prove that in these patients using local mucosa flaps is inappropriate.
  
  
  CONCLUSIONS
  The authors suggest that only a well vascularized flap as free flap must be used to cover the osteonecrosis area in patients with BRONJ stage III. Because of the structural instability of the mucosa in patients suffering of osteonecrosis Bf related the local flaps are prone to ulceration and to relapse.
authors: Dipartimento Di Discipline Chirurgiche Ed Oncologiche, Sezione Chirurgia Plastica , Universita Di Palermo, Italy.
authors: Sara Di
authors: SD
authors: Lorenzo
authors: Alberto
authors: A
authors: Trapassi
authors: Bartolo
authors: B
authors: Corradino
authors: Adriana
authors: A
authors: Cordova
keywords: Aminobisphosphonates; Bisphosphonates; Osteonecrosis of the jaw
references: Bone. 2007 Sep;41(3):318-20
references: 17572168
references: Int J Oral Maxillofac Surg. 2012 Nov;41(11):1397-403
references: 22840716
references: Mol Pharmacol. 2001 Feb;59(2):193-202
references: 11160853
references: J Oral Pathol Med. 2012 Nov;41(10):788-92
references: 22650360
references: N Engl J Med. 1996 Oct 3;335(14):1016-21
references: 8793925
references: Support Care Cancer. 2008 Nov;16(11):1311-5
references: 18663482
references: Bone. 2009 Jan;44(1):4-10
references: 18948230
references: Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Oct;102(4):433-41
references: 16997108
references: N Engl J Med. 2006 Nov 30;355(22):e25
references: 17135579
references: J Oral Maxillofac Pathol. 2012 May;16(2):210-4
references: 22923892
references: Dig Dis Sci. 2007 Aug;52(8):1879-89
references: 17410434
references: J Oral Maxillofac Surg. 2004 May;62(5):527-34
references: 15122554
references: J Oral Maxillofac Surg. 2012 Aug;70(8):1844-53
references: 22595135
references: Expert Opin Pharmacother. 2008 Jun;9(8):1351-61
references: 18473709