Surgical Treatment of Bisphosphonate-Related Osteonecrosis of the Jaws with the Use of Buccal Fat Pad: Case Report

Abstract

Bisphosphonate-related osteonecrosis of the jaws (BROJ) has been described since 2003 as an adverse effect of bisphosphonate medications. These drugs act on the vasculature and bone remodeling, mainly on osteoclastic activity and can cause areas of necrotic bone exposure. Treatment for the BROJ is not yet defined, but surgical treatment is one of the forms proposed, which may cause oral deformities like sinus communication in some cases. In situations like this the buccal fat pad is an important alternative for coating nasal-oral communications, due its large blood supply, elasticity, absence of restriction by age and safety. This paper presents the case of a 58-year-old woman with BROJ in the left maxilla caused by the use of zoledronic acid for metastatic breast cancer. The extensive necrotic bone area was surgically removed resulting in oral sinus communication. A buccal fat pad was used to cover the defect. More studies should be performed regarding the treatment of BROJ but, if necessary, a buccal fat pad flap could be an alternative to solve nasal-oral communications related to BROJ.

The Treatment of Medication-Related Osteonecrosis of the Jaw (MRONJ): A Systematic Review with a Pooled Analysis of Only Surgery versus Combined Protocols

“…This may, in part, be due to the heterogeneity of MRONJ staging and available treatments; indeed, the majority of proposed protocols are surgical (conservative or aggressive). A conservative surgical approach can be deployed with the debridement of the superficial necrotic bone or by sequestrectomy, in addition to the use of systemic antibiotics and local antiseptic products [62][63][64][65][66][67][68][69]. An aggressive surgical approach will be adopted when conservative debridement has failed; in advanced cases of MRONJ, it is characterized by the partial or total resecting of the necrotic/non-necrotic tissue [70][71][72].…”

Surgical treatment of medication‐related osteonecrosis of the upper jaw: Case series

“…BFPF is a valuable technique characterized by its sufficient blood supply, easy mobilization, and long-term post-surgical stability. The use of BFPF was reported to be successful in closing OACs related to MRONJ (Duarte, Alonso, Basso, & Dib, 2015;Gallego, Junquera, Pelaz, Hernando, & Megias, 2012;Melville et al, 2016;Rotaru, Kim, Kim, & Park, 2015).…”

Treatment of Medication-Related Osteonecrosis of the Jaws without Segmental Resections: A Case Series

“…Furthermore, of the 3 patients with MRONJ stage 3 who underwent marginal resections, 2 developed disease in the mandible and 1 in the maxilla, and most importantly, no patient required segmental resection. Additionally, the only patient who underwent maxillary marginal resection presented wide exposure of the maxillary sinus, requiring the use of a pedicled graft with a buccal fat pad [ 15 ].…”