Etiology and treatment of osteonecrosis of the mandible

Abstract

Aim of the studyPost-radiogenic osteonecrosis of the mandible is a serious complication in patients with combined treated head/neck tumors. Osteonecrosis of the mandible can also occur following administration of bisphosphonates. In the present article we would like to present our experiences over the last five years in treating both bisphosphonate-associated osteonecrosis and osteoradionecrosis.Material and methodsOf the patients treated in our hospital for bone necrosis of the mandible between January 2005 and June 2010, 16 were diagnosed with infected osteoradionecrosis and 10 with bisphosphonate-associated osteonecrosis. The patients with osteoradionecrosis were administered the classic osteomyelitis treatment. The same procedure was carried out on 5 of the 10 patients with bisphosphonate-associated osteonecrosis; the remaining 5 were treated conservatively due to advanced bone infection. The bone biopsies and specimens of both entities yielded by the surgical interventions were examined histologically after decalcification.ResultsOf the 16 patients treated for infected osteoradionecrosis, 7 recovered after decortication and long-term antibiosis. In 7 cases consolidation did not occur until after osseous continuity resection. In 2 cases the progress of the intraosseous infection could not be stopped with treatment.A typical first symptom of bisphosphonate-associated osteonecrosis was an alveolus that would not heal after a tooth extraction. In 50% of patients with bisphosphonate-associated osteonecrosis recovery was successful with a combination of surgery and long-term antibiosis. In the other patients with advanced bisphosphonate-associated osteonecrosis no definitive cure for the infection of the necrotic bone was possible.ConclusionIn terms of treatment, osteoradionecrosis proves complex, yet easier to treat than bisphosphonate-associated osteonecrosis. The removal of the infected bone tissue is often necessary, but it does not always lead to recovery. Therefore it can be concluded that prevention of intraosseous infection by consistent pretherapeutic dental hygiene is especially important.

Primary Chronic Osteomyelitis of the Jaws in Children: An Update on Pathophysiology, Radiological Findings, Treatment Strategies, and Prospective Analysis of Two Cases

“…It is well known that the removal of necrotic tissue in secondary chronic osteomyelitis of the mandible has a favorable outcome [ 69 ]. However, the outcome of surgical intervention in treatment of patients with primary chronic osteomyelitis of the jaw is uncertain [ 2 , 14 , 20 , 36 , 37 ].…”

Bacterial spectrum analysis and antimicrobial susceptibility study of osteoradionecrosis of the jaw in Southern China

“…Osteoradionecrosis (ORN) is a complex metabolic and homeostatic deficiency due to irradiation‐induced tissue injury, which is caused and enhanced by a combination of factors such as the radiation dose, the odontogenic or traumatic procedures, the virulence of microorganisms, the anatomic possibilities for the infection to spread, the immunologic dysfunction, and the systemic diseases (Aitasalo et al, 1998; Bast et al, 2013). To treat early‐stage ORNJ, conservative management such as anti‐inflammation, irrigation, and hyperbaric oxygen therapy (HBO) may be sufficient (Beumer et al, 1984).…”

Osteonecrosis of the jaw in patients with inflammatory bowel disease treated with tumour necrosis factor alpha inhibitors

“…Medication-related osteonecrosis of the jaw (MRONJ) is a disabling condition with increasing incidence, a high burden on quality of life, and poor outcomes. Only 50-60% of patients make a full recovery with mucosal healing [1][2][3][4] . Typically, bisphosphonates and denosumab have been associated with this disease, although anti-angiogenic agents have also been reported to cause MRONJ 4,5 .…”