[Evaluation of healing time of osteochemonecrosis of the jaw after surgery: Single-center retrospective study and review of the literature].
BACKGROUND
Osteochemonecrosis of the jaw (ONJ) is a chronic ischemic bone exposure. It has an increasing incidence. ONJ is mainly related to bisphosphonate and denosumab therapies in oncologic settings. Healing is considered uncertain ad as occurring slowly. International recommendations suggest to treat ONJ symptomatically in a first attempt. A surgical procedure, potentially aggressive, should be carefully weight up in patients in poor condition and whose life expectancy is often limited. However, surgical treatment seems to allow for a high rate of clinical remission. Postoperative remission periods, when mentioned in the studies, are disparate. The aim of our study was to clarify the remission period of ONJ after surgical management.


METHODS
A retrospective study was conducted on all patients operated for an ONJ at stage 2 and 3 in the Department for Oral and Maxillofacial Surgery - University Hospital of Besançon (France) from January 2006 to September 2015. Healing was defined as complete mucosal closure and asymptomatic site. Stage of the disease, the number and the type of surgery and the time between the last operation and the healing was noticed. These data were compared to an exhaustive review of the literature on PubMed with the following key-words: "osteonecrosis" AND "jaw" AND "surgery" AND "management". Only the articles giving the healing period were included.


RESULTS
Regarding the single-center retrospective study, the files of 23 patients could be included. Fifteen percent of the patients benefited from several procedures under general anesthesia. Twenty percent had a stage 3 ONJ and 80 % had a stage 2 ONJ. Twenty-five interventions were performed on 23 sites in 20 patients. Immediate healing after surgery occurred in 35 % of the patients. At 6 months after surgery, 57 % of the treated areas were healed. Twenty percent of the patients had died. The healing rate did not improve further after 6 months postoperatively. Regarding the review of the literature, 7 articles could be included. The mean postoperative healing period was 60.7 % at 6 months, 71.1 % at 12 months and 69.5 % at 18 months.


CONCLUSIONS
Our study shows that the postoperative healing rate of ONJ lies between 57 and 66.7 % at 6 months and that this rate was optimized in the order of 10 % to 12months and stable at 18months postoperatively. The ONJ of our series were partially or fully linked to other drugs than bisphosphonates in 70 % of the cases: 50 % were related to denosumab, alone or in combination and 35 % were related to an association with antiangiogenics, bevacizumab mainly.
Département d'odontologie et de chirurgie orale, CHU François Mitterrand, Dijon, France; Département de chirurgie maxillo-faciale, stomatologie et odontologie hospitalière, CHRU Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon, France. Electronic address: alexberquet@yahoo.fr.
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Berquet
Faculté de médecine, université de Franche-Comté, Besançon, France; Département de chirurgie maxillo-faciale, stomatologie et odontologie hospitalière, CHRU Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon, France.
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Louvrier
Département de chirurgie orale, service d'odontologie, hôpital de la Maison-Blanche, université Champagne-Ardennes, Reims, France; EA 481 neurosciences intégratives et cliniques, Besançon, France; Centre hospitalier La Chartreuse, 21033 Dijon, France.
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Denis
Inserm (French National Institute of Health and Medical Research), "Osteoarticular and Dental Regenerative Nanomedicine" laboratory, UMR 1109, faculté de médecine, FMTS, 67085 Strasbourg cedex, France; Université de Strasbourg, faculté de chirurgie dentaire, Strasbourg, France; Pôle de médecine et de chirurgie bucco-dentaires, unité de pathologie-chirurgie buccale, hôpitaux universitaires de Strasbourg, Strasbourg, France.
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Bornert
Département de chirurgie maxillo-faciale, stomatologie et odontologie hospitalière, CHRU Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon, France; EA 4662 Nanomedicine Lab, université de Franche-Comté, 25000 Besançon, France.
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Weber
Département d'odontologie et de chirurgie orale, CHU François Mitterrand, Dijon, France; Département de chirurgie maxillo-faciale, stomatologie et odontologie hospitalière, CHRU Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon, France; EA 4662 Nanomedicine Lab, université de Franche-Comté, 25000 Besançon, France.
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Meyer
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000453:epidemiology* / Q000534:rehabilitation / Q000601:surgery*; D050071:Bone Density Conservation Agents / Q000009:adverse effects; D000069448:Denosumab / Q000009:adverse effects; D004164:Diphosphonates / Q000009:adverse effects; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D056948:Orthognathic Surgical Procedures / Q000379:methods / Q000534:rehabilitation* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D014945:Wound Healing / Q000502:physiology*
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D000069448:Denosumab
Care; Chirurgie; Guérison; Healing; Jaw; Maxillaire; Osteonecrosis; Ostéonécrose; Prise en charge; Surgery