Long-term follow-up of jaw osteomyelitis associated with bisphosphonate use in a tertiary-care center

OBJETIVES: This study reviews our experience in bisphosphonate-associated jaw osteomyelitis (BJOM), focusing on the incidence, etiology, treatment, and long-term outcome. Methods Retrospective review of the clinical histories adult patients diagnosed with BJOM (1995-2008) in a tertiary hospital. Results BJOM was found in 30 of 132 (22.7%) consecutive patients with jaw osteomyelitis. The percentage of BJOM cases increased from 8.7% (4/46) in 1995-2005 to 30.2% (26/86) in 2005-2008. Symptoms appeared in a median of 2.5 years after intravenous use, and 4.5 years after oral exposure. Viridans group streptococci were isolated in 83.3% of cases. Actinomyces spp. was found in 16 (39.0%) of 41 bone histologies. All included patients received a median of 6 months of appropiate antibiotic therapy and a surgical procedure (debridament and/or sequestrectomy). Thirteen of 27 cases (48.1%) with long-term follow-up (median 22 months, IQR 25-75 17-28) failed. Clinical failure defined as, persistent infection or relapse, was more frequent in patients receiving intravenous than oral bisphosphonates (11/16 [68.8%] vs. 2/11 [18.2%]; P < .05) and in cases with Actinomyces spp. (7/10 [70.0%] vs6/17 [35.3%]; P = .08).Conclusions Bisphosphonate therapy is now a frequent cause of JO. BJOM is difficult to cure and relapses are common, particularly in patients exposed to intravenous bisphosphonates

OBJETIVOS: Analizar la incidencia, la etiología, el tratamiento y la evolución clínica a largo plazo de la osteomielitis maxilar (OM) asociada al tratamiento con bifosfonatos (OMAB). MÉTODOS: Estudio retrospectivo de pacientes adultos con diagnóstico de OMAB (1995-2008) en un hospital universitario. RESULTADOS: Fueron diagnosticadas 30OMAB de un total de 132OM. Desde el año 1995 al 2004 fueron diagnosticadas 4OMAB de 46OM (8,7%), y desde el año 2005 al 2008, 26 de 86 (30,2%). Los síntomas de osteomielitis aparecieron en una mediana de 2,5años en los pacientes que recibieron el tratamiento con bifosfonatos por vía intravenosa y una mediana de 4,5 años en los pacientes que lo recibieron por vía oral. En el 83,3% se aislaron Streptococcus del grupo viridans. En 16 (39%) de 41muestras enviadas para estudio histológico se constató la presencia de Actinomyces spp. Todos los pacientes fueron sometidos a desbridamiento quirúrgico y/o secuestrectomía y recibieron una mediana de 6meses de tratamiento antibiótico. Trece de los 27casos (48,1%) con seguimiento a largo plazo (mediana 22meses, IQR25-75 17-28) presentaron fracaso terapéutico. Estos fueron más frecuentes en pacientes que recibieron bifosfonatos por vía intravenosa en comparación con los que los recibieron por vía oral (11/16 [68,8%] vs 2/11 [18,2%], p < 0,05) y en los casos con Actinomyces spp. (7/10 [70,0%] vs 6/17 [35,3%], p = 0,08). CONCLUSIONES: Actualmente el tratamiento con bifosfonatos es causa frecuente de OM. Las recidivas son frecuentes en las OMAB, especialmente en pacientes expuestos a los bifosfonatos por vía intravenosa

Long-term follow-up of jaw osteomyelitis associated with bisphosphonate use in a tertiary-care center.

OBJECTIVES: This study reviews our experience in bisphosphonate-associated jaw osteomyelitis (BJOM), focusing on the incidence, etiology, treatment, and long-term outcome. METHODS: Retrospective review of the clinical histories adult patients diagnosed with BJOM (1995-2008) in a tertiary hospital. RESULTS: BJOM was found in 30 of 132 (22.7%) consecutive patients with jaw osteomyelitis. The percentage of BJOM cases increased from 8.7% (4/46) in 1995-2005 to 30.2% (26/86) in 2005-2008. Symptoms appeared in a median of 2.5 years after intravenous use, and 4.5 years after oral exposure. Viridans group streptococci were isolated in 83.3% of cases. Actinomyces spp. was found in 16 (39.0%) of 41 bone histologies. All included patients received a median of 6 months of appropiate antibiotic therapy and a surgical procedure (debridament and/or sequestrectomy). Thirteen of 27 cases (48.1%) with long-term follow-up (median 22 months, IQR 25-75 17-28) failed. Clinical failure defined as, persistent infection or relapse, was more frequent in patients receiving intravenous than oral bisphosphonates (11/16 [68.8%] vs. 2/11 [18.2%]; P < .05) and in cases with Actinomyces spp. (7/10 [70.0%] vs6/17 [35.3%]; P = .08). CONCLUSIONS: Bisphosphonate therapy is now a frequent cause of JO. BJOM is difficult to cure and relapses are common, particularly in patients exposed to intravenous bisphosphonates.

Sarcomas mandibulares: experiencia quirúrgica en los últimos 10 años / Mandibular sarcomas: surgical experience over the past 10 years

Introducción: Los sarcomas mandibulares representan una entidad de difícil estudio por su escasa incidencia e histopatología. Pacientes y métodos: Presentamos la experiencia del servicio de Cirugía Oral y Maxilofacial del Hospital Vall d’Hebron de Barcelona en los últimos 10 años (2001-2010) en el manejo de los sarcomas mandibulares, realizando una revisión retrospectiva de 12 casos de pacientes afectos por este tipo de tumor. Resultados: La técnica más utilizada para la reconstrucción fue el colgajo microvascularizado (hueso peroné: 8/12), recibiendo tratamiento adyuvante (quimioterapia y/o radioterapia) el 82% de los pacientes. Cinco pacientes fallecieron (42%), 2 se encuentran con progresión de la enfermedad (16%) y 5 sobreviven libres de enfermedad (42%) hasta la finalización del seguimiento. Conclusiones: Los casos descritos representan una serie singular debido a la localización mandibular, no antes publicadas en la literatura. Aún así, los resultados obtenidos en términos de supervivencia y factores pronóstico son similares a los descritos para los sarcomas de cabeza y cuello. La consecución de márgenes libres con la cirugía es la clave del tratamiento, siendo necesario el tratamiento complementario para mejorar el pronóstico(AU)

Introduction: Sarcomas located in the mandible are difficult to study due to their relatively rare appearance and histology. Patients and Methods: We present the experience of the Oral and Maxillofacial Surgery Department of the Vall d’Hebron Hospital in Barcelona over the last 10 years (2001-2010) in the management of jaw sarcomas, performing a retrospective review of 12 cases of patients affected by this type of tumour. Results: The technique mostly used for the reconstruction was the microvascularised bone graft (fibula: 8/12), with 82% of the patients receiving adjuvant therapy (chemotherapy and radiotherapy). Five of the patients died (42%), twowere found with disease progression (16%), and 5 survived free of disease (42%) until the end of follow-up. Conclusions: The cases described are a unique series due to the mandibular location. Prognostic factors and survival rates are similar to those described for head and neck sarcomas. Free margin during surgery must be the goal of treatment, additional chemotherapy or radiotherapy or both being required to improve the survival rates(AU)