title: Stage 3 Medication-Related Osteonecrosis of the Posterior Maxilla: Surgical Treatment Using a Pedicled Buccal Fat Pad Flap: Case Reports.
abstract: OBJECTIVE
  Stage 3 medication-related osteonecrosis of the jaw (MRONJ) sometimes requires surgical treatment for resolution of the pathology and, in many cases, leads to oroantral communication in the posterior maxilla. The buccal fat pad flap is considered the best surgical choice for closure of large oroantral communications because it provides primary closure and guarantees adequate bone protection with sufficient blood supply for an effective bone healing process.
  
  
  METHODS
  Five consecutive patients affected by stage 3 posterior maxillary MRONJ were treated with surgical removal of the necrotic bone and primary closure of the oroantral communication using a buccal fat pad flap.
  
  
  RESULTS
  In each case, the size of the flap was always sufficient to perfectly close the defect without tension. There were no postoperative complications and the average postoperative hospital stay was 3 ± 1 days. The patients were seen at monthly follow-ups; after 12 ± 4 months of follow-up, no problems were noted in the treated area.
  
  
  CONCLUSIONS
  Despite the limited number of cases, the results of this study suggest that, for stage 3 posterior maxilla MRONJ, managing the site with a pedicled buccal fat pad flap and primary closure might guarantee adequate bone protection with sufficient blood supply for an effective bone healing process.
authors.affiliation: Resident, PhD Program in Experimental Medicine and Therapy, Department of Oncology, University of Turin, Turin, Italy. Electronic address: mattia.berrone@unito.it.
authors.forename: Mattia
authors.initials: M
authors.lastname: Berrone
authors.affiliation: Resident, Oral Surgery Specialty School, Department of Oncology, University of Turin, Turin, Italy.
authors.forename: Filippo Umberto
authors.initials: FU
authors.lastname: Florindi
authors.affiliation: Member of the medical staff Oral Surgery Unit, Department of Oncology, University of Turin, Turin, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Carbone
authors.affiliation: Resident, Oral Surgery Specialty School, Department of Oncology, University of Turin, Turin, Italy.
authors.forename: Carola
authors.initials: C
authors.lastname: Aldiano
authors.affiliation: Associate Professor, Oral Medicine and Oral Oncology Unit, Department of Oncology, University of Turin, Turin, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Pentenero
mesh_terms: D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008439:Maxillary Diseases / Q000139:chemically induced* / Q000601:surgery*; D009061:Mouth Mucosa; D010020:Osteonecrosis / Q000139:chemically induced* / Q000601:surgery*; D013524:Surgical Flaps