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Reconstructive Surgery Following Bisphosphonate-Related Osteonecrosis of the Jaws: Evolving Concepts

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Plastic and Thoracic Surgery, Orthopedics and Ophthalmology

Part of the book series: Recent Clinical Techniques, Results, and Research in Wounds ((RCTRRW,volume 4))

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Abstract

Bisphosphonates inhibit normal and pathological bone resorption by osteoclasts. These drugs reduce osteoclast binding to the bone, decrease the production of new osteoclasts, and stimulate osteoclast apoptosis. Bisphosphonates also have antiangiogenic properties. This results in a decreased bone turnover, with hypermineralization and bone hypovascularization. Combination of a compact and avascular bone is believed to result in osteonecrosis by a mechanism of ischemia and secondary infection. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) affects the mandible and maxilla almost exclusively, with the mandible two times more likely to be affected than the maxilla. Although it is unclear why the jaw is particularly vulnerable to this condition, putative reasons include high bone turnover because of microtrauma from mastication, high bone density of the jaw, and the susceptibility to infection because of close proximity to the oral cavity. The therapeutic goals in BRONJ are preservation of the quality of life and management and prevention of pain, infection, and progression of lesions. Complication rates after microvascular reconstruction using a free flap in the treatment of BRONJ seem acceptable. Most patients enjoy good to excellent functional and aesthetic results after free-flap reconstruction. We believe segmental resection and microvascular reconstruction may be a valid option in select advanced cases of BRONJ and that the treatment algorithm of these cases may be redefined in the near future.

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Authors and Affiliations

  1. Department of Maxillo-Facial Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Giuseppe Spinelli, Francesco Arcuri, Domenico Valente, Mirco Raffaini & Tommaso Agostini

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  1. Giuseppe Spinelli
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  2. Francesco Arcuri
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  3. Domenico Valente
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  4. Mirco Raffaini
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  5. Tommaso Agostini
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Correspondence to Tommaso Agostini .

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  1. Tustin, CA, USA

    Melvin A. Shiffman

  2. Newport Beach, CA, USA

    Mervin Low

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Spinelli, G., Arcuri, F., Valente, D., Raffaini, M., Agostini, T. (2018). Reconstructive Surgery Following Bisphosphonate-Related Osteonecrosis of the Jaws: Evolving Concepts. In: Shiffman, M., Low, M. (eds) Plastic and Thoracic Surgery, Orthopedics and Ophthalmology. Recent Clinical Techniques, Results, and Research in Wounds, vol 4. Springer, Cham. https://doi.org/10.1007/15695_2017_70

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  • DOI: https://doi.org/10.1007/15695_2017_70

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