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J Craniomaxillofac Surg ; 40(8): 719-25, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22336489

RESUMO

INTRODUCTION: Bisphosphonates are used to reduce skeletal related events in patients with bone consuming diseases such as osteoporosis and bone metastases. However recently there has been an increased awareness of bisphosphonate-associated necrosis of the jaws (BP-ONJ). Many authors propose conservative management in these cases but invariably the problem is not treated successfully allowing the bone defect to worsen. Recently there has been a move to treat this problem surgically. The aim of this retrospective study was to provide a surgical solution for patients suffering from BP-ONJ. MATERIALS AND METHODS: All patients presenting with BP-ONJ were treated with bone debridement of the affected area and multilayer wound closure. The considered variables were: gender, age, underlying diagnosis, type of bisphosphonate (BP) used, duration of bisphosphonate use, route of administration, location of the osteonecrosis, clinical symptoms, association with dental treatment and surgical outcome. RESULTS: Nineteen cases of a total of 21 demonstrated no recurrence of osteonecrosis during follow up (Mean 16 months - Range 12-24 months). One patient with a bilateral defect showed a dehiscence on one side and a small fistula on the contralateral side 6 weeks post-operatively and required revision surgery. Another patient developed a fistula after 4 weeks that was treated successfully with antibiotics and curettage. No patients had evidence of exposed bone, bland mucosa nor pain at the surgical site. CONCLUSION: The technique described can be recommended for patients with BP-ONJ if a conservative treatment fails.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/cirurgia , Idoso , Idoso de 80 Anos ou mais , Alendronato/administração & dosagem , Alendronato/efeitos adversos , Conservadores da Densidade Óssea/administração & dosagem , Conservadores da Densidade Óssea/efeitos adversos , Conservadores da Densidade Óssea/classificação , Desbridamento/métodos , Assistência Odontológica , Difosfonatos/administração & dosagem , Difosfonatos/efeitos adversos , Difosfonatos/classificação , Feminino , Seguimentos , Humanos , Imidazóis/administração & dosagem , Imidazóis/efeitos adversos , Masculino , Doenças Mandibulares/cirurgia , Pessoa de Meia-Idade , Fístula Bucal/etiologia , Osteotomia/métodos , Complicações Pós-Operatórias , Estudos Retrospectivos , Retalhos Cirúrgicos , Deiscência da Ferida Operatória/etiologia , Técnicas de Sutura , Resultado do Tratamento , Ácido Zoledrônico
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