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Local and Microvascular Free Flaps in Patients with Medication-Related Osteonecrosis of the Jaw

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Medication-Related Osteonecrosis of the Jaws

Abstract

Medication-and especially Bisphosphonate-related osteonecrosis of the jaw (MRONJ/BRONJ, also known as bisphosphonate-induced osteonecrosis and antiresorptive drug-induced osteonecrosis) is considered a therapy-resistant form of osteonecrosis. Despite this conservative and surgical treatment, regimens have been attempted and recommended in the years since it was first identified.

The key points after surgical debridement of the exposed bone sites are to close the wounds in a watertight manner to avoid exposure to the oral milieu and reinfection of the bone surface that has been rendered almost impossible to respond to challenges that require remodeling – essentially the purpose of the bisphosphonate and related drugs. While there are techniques described in the literature capable of achieving this aim, the relevance of patients’ comorbidities and prognosis plays a very substantial part in planning logical individualized treatment. Many of these patients, often those worst affected, are suffering from malignant diseases with limited prognosis. Therefore, the choice of defect closure technique should also consider the individual situation of each patient; was the drug used for prophylaxis in osteoporosis or for advanced metastatic malignancy?

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Klinikum Rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany

    Thomas Mücke MD, DDS, PhD

  2. Bradford Teaching Hospitals NHS Foundation Trust, Oral and Facial Specialties Department Duckworth Ln, West Yorkshire, BD9 6RJ, Bradford, UK

    David A. Mitchell MBBS, BDS FDS, FRCS

Authors
  1. Thomas Mücke MD, DDS, PhD
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  2. David A. Mitchell MBBS, BDS FDS, FRCS
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Correspondence to Thomas Mücke MD, DDS, PhD .

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Editors and Affiliations

  1. Department of Oral and Maxillofacial Sur, Ludwig-Maximilians-University of Munich, Munich, Germany

    Sven Otto

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Mücke, T., Mitchell, D.A. (2015). Local and Microvascular Free Flaps in Patients with Medication-Related Osteonecrosis of the Jaw. In: Otto, S. (eds) Medication-Related Osteonecrosis of the Jaws. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-43733-9_8

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  • DOI: https://doi.org/10.1007/978-3-662-43733-9_8

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  • Print ISBN: 978-3-662-43732-2

  • Online ISBN: 978-3-662-43733-9

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