Article
Bisphosphonate-associated osteonecrosis – most frequent osteopathy in craniomaxillofcial surgery 10 years later
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Published: | March 21, 2014 |
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Introduction: Over one hundred years upon the first synthesis of the geminal bisphosphonate (BP) by von Baeyer und Hoffmann (1897) and one decade (2003) since the initial report on the bisphosphonate-related of osteonecrosis of the jaw (ONJ) this osteopathy remains a serious clinical challenge. In the mean time occuring just more frequently than osteoradionecrosis of the facial skeleton.
Material and methods: In a monocentric study over the period of 2005 to 2013 all inpatients with manifestation of ONJ were prospectively included. The recorded data were the medical history, comorbidity, BP-treatment, risk factors, ONJ-localization and treatment, imaging and histomorphological features as well as complicatoins.
Results: 63 patients with an average age of 68,9 years were evaluated (32 male, 31 female).
Prostate and breast cancer (n=10, n=22) respectively multiple myeloma (n=13) were the three most frequent malignancies; and cardiovascular diseases, diabetes mellitus as well as nephrological disorders were the most important comorbidities. In 66,7% of all patients zoledronate was associated with the ONJ. The average duration of BP-treatment was found to be 38±28 months. The severity of the ONJ (stage II and stage III according to AAOMS 2009) was found to be equally distributed (pathological mandibular fractures n=3, sinusitis maxillaris n=3) beeing prodominantly localised in the mandibula (Figure 1 [Fig. 1]). Thus, needing resections in 13 cases with following defect configurations (Boyd et al. 1993): L-Defect n=10, H-Defect n=1, C-Defect n=1, LL-Defect n=1), which presents the most difficult conditions.The histological aspect of ONJ shows a chronical granulary but predominantly suppurative inflammation with osteonecrosis including Actinomyces species.
Conclusion: The current comprehensive knowledge about pathogenesis of ONJ reveales:
- reduction of the osteocyte count
- antiangiogenesis
- reduced proliferation und migration capacity of epithelial cells
- osteosclerosis
- disturbed mucosal or gingival integrity
- prolonged wound healing
- disturbed bone remodeling
- biofilm (Yoneda et al. 2010, Landesberg 2011).
With the focus on identification of risk factors, early recognition and better treatment of ONJ a multidisciplinary approach is essential.