Free flap reconstruction for patients with bisphosphonate related osteonecrosis of the jaws after mandibulectomy

Mücke, Thomas; Jung, Maximilian; Koerdt, Steffen; Mitchell, David A.; Loeffelbein, Denys J.; Kesting, Marco

doi:10.1016/j.jcms.2015.11.015

Cited by 20 publications

(13 citation statements)

References 44 publications

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“…A limited number of studies proposed free flaps for MRONJ lesions, mostly mandibular lesions, with poor vascularization and large soft tissue defects (Hanasono, Militsakh, Richmon, Rosenthal, & Wax, ; Mucke et al, ; Seth, Futran, Alam, & Knott, ; Vercruysse, Backer, & Mommaerts, ). Mucke et al () reported successful reconstruction of four maxillary lesions reconstructed with radial forearm flap and one with anterolateral thigh flap. The limitations of these techniques include their complexity, long operative time, risk of donor site morbidity, and particularly the complexity of postoperative prosthetic rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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Purpose The management of maxillary medication‐related osteonecrosis of the jaw (MRONJ) is challenging. Therefore, identifying the proper treatment is important. This study aimed to evaluate the surgical treatment of maxillary MRONJ using single‐layer closure with mucoperiosteal flap and double‐layer closure with buccal fat pad flap (BFPF) and mucoperiosteal flap and to find the outcomes after rehabilitation with obturators. Methods A retrospective analysis was conducted and included all surgically treated and followed‐up maxillary MRONJ cases in a single center. Demographics and clinical data, stage of MRONJ, surgical treatment, and treatment outcome were collected. Results Seventy‐nine lesions were included. Removal of necrotic bone was followed by coverage with mucoperiosteal flap in 60 lesions and BFPF in 14 lesions. Seven lesions (five primarily and two following unsuccessful treatment with BFPF) underwent necrectomy and were reconstructed with obturators. Complete mucosal healing was achieved in 76.7% of the lesions covered with mucoperiosteal flap. BFPF led to complete mucosal healing in 85.7% of the lesions. No complications were observed in the defects rehabilitated with obturators. Conclusion Removal of necrotic bone followed by closure with mucoperiosteal flap is reliable for MRONJ treatment. BFPF is effective for closure of MRONJ‐related oroantral communications (OACs).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…Aggressive radical surgery is offered only to symptomatic patients with extensive osteonecrosis, including those who have previously failed conservative treatments [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Microsurgical Reconstruction of the Jaws Using Vascularised Free Flap Technique in Patients with Medication-Related Osteonecrosis: A Systematic Review

Sacco

Hamid

et al. 2018

BioMed Research International

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Background Osteonecrosis of the jaw (ONJ) has been reported to be associated with patients receiving primarily bisphosphonate (BP) therapies. However, lately it has been documented that other medications, such as RANK ligand inhibitor (denosumab) and antiangiogenic drug, can cause ONJ. Micro-osseous-vascular reconstruction of the jaws in patients affected by medication-related osteonecrosis of the jaw represents a viable option of treatment for patients affected by stage III of the disease. However, there are still considerable doubts about the success of this procedure in the short, medium, and long term. Material and Methods A multidatabase (PubMed/MEDLINE, EMBASE, and CENTRAL) systematic search was performed. Any type of studies considering human patients treated with antiresorptive and antiangiogenic drugs was considered. The aim of the research is to primarily understand the success rate of micro-osseous-vascular reconstruction in the short, medium, and long period of time. This review has also the goal of better understanding any perioperative and postoperative complications resulting from the use of the reconstruction techniques. Results Eighteen studies resulted eligible for the study. Fibula free flap is the most commonly utilised vascularised free flap reconstruction technique (80.76%). Ten out of eighteen studies reported no complications. Recurrence of osteonecrosis was registered in five cases (6.41%) after free flap reconstruction. The overall free flap success rate was 96.16%. Conclusions Based on the limited data available in literature (Level 4 of the Oxford Evidence-based medicine scale), micro-osseous-vascular reconstruction of the jaws represents a valid treatment in patients with bisphosphonate-related osteonecrosis at stage III of the disease. However, additional data based on a larger cohort of patients are necessary to justify this type of intervention in patient affected by MRONJ.

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“…Because recurrence has been shown to be of prognostic value in relation to the development of complications, 20,72 a more radical single treatment early on in a selected subset of patients should be considered rather than repeated unsuccessful debridements. 20,73 A limited number of cases have described patients with refractory BRONJ treated by microvascular free flaps. 28,29,31,69,71,[74][75][76] Other studies demonstrated the success of osseocutaneous fibula flap reconstructions in BRONJ patients.…”

Section: Therapymentioning

confidence: 99%

Bisphosphonate and Medication-Related Osteonecrosis of the Jaw: A Review

Mücke

Krestan

Mitchell

et al. 2016

Semin Musculoskelet Radiol

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For patients with malignant disease taking bisphosphonates and denosumab, the incidence of medication-related osteonecrosis of the jaw (MRONJ) is up to 15% in contrast to 0.01% in patients with osteoporosis. Clinical presentation of MRONJ extends from asymptomatic exposure of bone in 94% of patients to severe cases of mandibular fractures in a minority of 4.5%. The strongest risk factors for MRONJ are invasive dental procedures and dental infections. Advances in imaging provide more preoperation information compared with panoramic radiograph. Prevention strategies are the elimination of potential risk factors leading to invasive dental procedures and maintenance of good oral hygiene prior to the administration of antiresorptive agents. Management of MRONJ depends on the underlying disease, extent of the necrosis, and the presence of contributing therapy. Conservative therapies include topical anti-infective rinses and systemic antibiotic therapy. The most important part of surgical therapy is to remove the exposed and necrotic bone. Several options for defect closure are possible from local tissue flaps to microvascular free flap procedures. The development of MRONJ in conjunction with dental implants is a severe side effect and should be avoided if potentially harmful medication has already been administered.

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Free flap reconstruction for patients with bisphosphonate related osteonecrosis of the jaws after mandibulectomy

Cited by 20 publications

References 44 publications

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

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

Microsurgical Reconstruction of the Jaws Using Vascularised Free Flap Technique in Patients with Medication-Related Osteonecrosis: A Systematic Review

Bisphosphonate and Medication-Related Osteonecrosis of the Jaw: A Review

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