title: Successful surgical management of osteonecrosis of the jaw due to RANK-ligand inhibitor treatment using fluorescence guided bone resection.
abstract: Osteonecrosis of the jaw has recently been described in patients receiving subcutaneous administration of RANKL-inhibitors (denosumab). However, due to promising study results, more patients will receive denosumab in order to avoid skeletal complications due to metastatic bone disease and osteoporosis. Therefore, this has the potential to become a comparable challenge to the bisphosphonate induced jaw necrosis in the area of Oral and Maxillofacial Surgery. Indeed, so far no convincing surgical technique has been described to overcome the non-healing mucosal lesions with exposed bone due to RANKL-inhibitor therapy. In this technical note, we report two successful cases of surgical treatment of jaw-bone necrosis under RANKL-inhibitor treatment using fluorescence guided bone resection. In conclusion, the technique is suggested as treatment option for this entity of osteonecrosis of the jaw.
authors.affiliation: Department of Oral and Maxillofacial Surgery (Chair: Prof. Dr. Dr. M. Ehrenfeld), Ludwig-Maximilians University, Lindwurmstraße 2a, München 80337, Germany. Electronic address: Otto_Sven@web.de.
authors.forename: Sven
authors.initials: S
authors.lastname: Otto
authors.forename: Sebastian
authors.initials: S
authors.lastname: Baumann
authors.forename: Michael
authors.initials: M
authors.lastname: Ehrenfeld
authors.forename: Christoph
authors.initials: C
authors.lastname: Pautke
mesh_terms: D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects*; D000069448:Denosumab; D004318:Doxycycline; D005260:Female; D005456:Fluorescent Dyes; D006801:Humans; D007279:Injections, Subcutaneous; D008336:Mandibular Diseases / Q000139:chemically induced / Q000601:surgery*; D008875:Middle Aged; D061848:Optical Imaging / Q000379:methods; D010020:Osteonecrosis / Q000139:chemically induced / Q000601:surgery*; D010027:Osteotomy / Q000379:methods; D053245:RANK Ligand / Q000037:antagonists & inhibitors*; D014081:Tooth Extraction; D020390:Tooth Socket / Q000601:surgery; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D005456:Fluorescent Dyes; D053245:RANK Ligand; C505688:TNFSF11 protein, human; D000069448:Denosumab; D004318:Doxycycline
keywords: Denosumab; Drug induced necrosis; Fluorescence guided bone resection; Jaw osteonecrosis; ONJ; Treatment