Reconstructive and ophthalmologic outcomes following resection of spheno-orbital meningiomas.

PURPOSE: To assess long-term stability and aesthetic and functional outcomes of orbital reconstruction after resection of spheno-orbital meningiomas using calvarial bone grafts. METHODS: A series of 21 patients were retrospectively examined after an average follow-up period of 65.6 months with regard to their personal satisfaction and also proptosis, ocular function, and reconstructive outcome. The sagittal position of the globe was analyzed by CT and MRI. Patients were treated surgically in an interdisciplinary approach between 1997 and 2006. RESULTS: A permanent postoperative decrease in globe protrusion of 2.7 mm on average was achieved. Most patients (76%) reported identical or improved vision, 85% were satisfied with the reconstructive result, and 55% were free of discomfort in daily life. Seven patients suffered from recurrences that were invariably accompanied by globe protrusion. CONCLUSIONS: Calvarial bone grafts provide good, stable long-term results in the reconstruction of orbital defects. Globe protrusion is a reliable indicator for the detection of recurrences in spheno-orbital meningiomas. Because of high recurrence rates, it is advisable to continue follow-up for 20 or more years.

Principles of oral surgery for prevention of bisphosphonate-related osteonecrosis of the jaw.

OBJECTIVES: Principles and workflow are described to prevent bisphosphonate-related osteonecrosis of the jaw (BRONJ) when oral surgery is necessary in patients taking bisphosphonates. MATERIAL AND METHOD: A total of 117 surgical procedures were performed on 68 patients taking bisphosphonates. The basis of the treatment was (1) use of perioperative antibiotics; (2) after dentoalveolar surgical procedures, bone edges were smoothed and mucoperiosteal flaps were prepared to ensure tension-free wound closure; (3) sutures were not removed until 14 days postsurgery; (4) long-term results were evaluated. RESULTS: Ninety-seven percent of all procedures were simple and showed no complications. Only 3 patients with a long history of intravenous bisphosphonate medication developed BRONJ within 4 weeks after surgery. No patient receiving oral bisphosphonates developed BRONJ. No long-term failure was observed when primary wound healing was successful. CONCLUSIONS: The high success rate of the described surgical procedures imply dentoalveolar surgery with low risk of development of BRONJ is possible for patients taking bisphosphonates.