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Management of Large Oroantral Fistulas Caused by Medication-Related Osteonecrosis with the Combined Sequestrectomy, Buccal Fat Pad Flap and Platelet-Rich Fibrin

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Abstract

Purpose

The aim of this retrospective study was to describe the efficacy of management of bisphosphonate-related maxillary osteonecrosis, which had resulted in an oroantral fistula formation, by performing sequestrectomy, platelet-rich fibrin (PRF) and buccal fat pad (BFP) flap.

Patient and Methods

A total of 7 patients diagnosed with stage III maxillary medication-related osteonecrosis according to guidelines of the American Association of Oral and Maxillofacial Surgeons. All patients complained of persistent pain, swelling and purulent drainage with sinusitis. In order to keep the infection under control, the patients first received an antibiotic combination for 2 weeks. Then, sequestrectomy and bone debridement were performed under general anesthesia. After that, an antrectomy was performed via endoscopic sinus surgery in some cases. And the fistula was closed with BFP after or before the PRF application to the region depending on the size of the fistula.

Results

The fistula was successfully closed. After a mean follow-up of 16 months, no symptoms were seen in the patients.

Conclusions

The patients were successfully managed with a combined treatment consisted of sequestrectomy, PRF and BFP. We suggest that large defects arose from medication-related osteonecrosis of the jaw can be managed with such a combined approach in order to lessen the recurrence risk.

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References

  1. Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Agbaloo T, Mebrotra B, O’Ryan F (2014) American Association of oral and maxillofacial surgeons position paper on medication-related osteonecrosis of the jaw—2014 update. J Oral Maxillofac Surg 72(10):1938–1956

    Article  Google Scholar 

  2. Bamias A, Kastritis E, Bamia C, Moulopoulos LA, Melakopoulos I, Bozas G, Koutsoukou V, Gika D, Anagnostopoulos A, Papadimitriou C, Terpos E, Dimopoulos M (2005) Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: incidence and risk factors. J Clin Oncol 23(34):8580–8587

    Article  Google Scholar 

  3. Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL (2004) Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg 62(5):527–534

    Article  Google Scholar 

  4. Mast G, Otto S, Mucke T, Schreyer C, Bissinger O, Kolk A, Wolff KD, Ehrenfeld M, Stürzenbaum SR, Pautke C (2012) Incidence of maxillary sinusitis and oro-antral fistulae in bisphosphonate-related osteonecrosis of the jaw. J Craniomaxillofac Surg 40(7):568–571

    Article  Google Scholar 

  5. Maurer P, Sandulescu T, Kriwalsky MS, Rashad A, Hollstein S, Stricker I, Hölzle F, Kunkel M (2011) Bisphosphonate-related osteonecrosis of the maxilla and sinusitis maxillaris. Int J Oral Maxillofac Surg 40(3):285–291

    Article  CAS  Google Scholar 

  6. Dolanmaz D, Tuz H, Bayraktar S, Metin M, Erdem E, Baykul T (2004) Use of pedicled buccal fat pad in the closure of oroantral communication: analysis of 75 cases. Quintessence 35(3):241–246

    Google Scholar 

  7. Egyedi P (1977) Utilization of the buccal fat pad for closure of oro-antral and/or oro-nasal communications. J Maxillofac Surg 5(4):241–244

    Article  CAS  Google Scholar 

  8. Poeschl PW, Baumann A, Russmueller G, Poeschl E, Klug C, Ewers R (2009) Closure of oroantral communications with Bichat’s buccal fat pad. J Oral Maxillofac Surg 67(7):1460–1466

    Article  Google Scholar 

  9. Gallego L, Junquera L, Pelaz A, Hernando J, Megias J (2012) The use of pedicled buccal fat pad combined with sequestrectomy in bisphosphonate-related osteonecrosis of the maxilla. Med Oral Patol Oral Cir Bucal 17(2):e236–e241

    Article  CAS  Google Scholar 

  10. Rotaru H, Kim MK, Kim SG, Park YW (2015) Pedicled buccal fat pad flap as a reliable surgical strategy for the treatment of medication-related osteonecrosis of the jaw. J Oral Maxillofac Surg 73(3):437–442

    Article  Google Scholar 

  11. Roy S, Driggs J, Elgharably H, Biswas S, Findley M, Khanna S, Gnyawali U, Bergdall VK, Sen CK (2011) Platelet-rich fibrin matrix improves wound angiogenesis via inducing endothelial cell proliferation. Wound Repair Regen 19:753–766

    Article  Google Scholar 

  12. Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJJ, Mouhyi J, Gogly B (2006) Platelet-rich fibrin (PRF): a second generation platelet concentrate part II: platelet related biologic features. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 101:e45–e50

    Article  Google Scholar 

  13. He L, Lin Y, Hu X, Zhang Y, Wu H (2009) A comparative study of platelet rich fibrin (PRF) and platelet-rich plasma (PRP) on the effect of proliferation and differentiation of rat osteoblasts in vitro. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 108:707–713

    Article  Google Scholar 

  14. Gülşen U, Şentürk MF, Mehdiyev I (2016) Flap-free treatment of an oroantral communication with platelet-rich fibrin. Br J Oral Maxillofac Surg 54:702–703

    Article  Google Scholar 

  15. Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, Gogyl B (2006) Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part I: technological concepts and evolution. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 101:37–44

    Article  Google Scholar 

  16. Marx RE (2003) Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 61(9):1115–1117

    Article  Google Scholar 

  17. Wang J, Goodger NM, Pogrel MA (2003) Osteonecrosis of the jaws associated with cancer chemotherapy. J Oral Maxillofac Surg 61(9):1104–1107

    Article  CAS  Google Scholar 

  18. Migliorati CA (2003) Bisphosphanates and oral cavity avascular bone necrosis. J Clin Oncol 21(22):4253–4254

    Article  Google Scholar 

  19. Allen MR, Burr DB (2009) The pathogenesis of bisphosphonate-related osteonecrosis of the jaw: so many hypotheses, so few data. J Oral Maxillofac Surg 67(5 suppl):61–70

    Article  Google Scholar 

  20. Otto S, Hafner S, Mast G, Tischer T, Volkmer E, Schieker M, Stürzenbaum SR, Tresckow EV, Kolk A, Ehrenfeld M, Pautke C (2010) Bisphosphonate-related osteonecrosis of the jaw: is pH the missing part in the pathogenesis puzzle? J Oral Maxillofac Surg 68(5):1158–1161

    Article  Google Scholar 

  21. Sato M, Grasser W, Endo N, Akins R, Simmons H, Thompson DD, Golub E, Rodan GA (1991) Bisphosphonate action. Alendronate localization in rat bone and effects on osteoclast ultrastructure. J Clin Invest 88(6):2095–2105

    Article  CAS  Google Scholar 

  22. Bell GW, Joshi BB, Macleod RI (2011) Maxillary sinus disease: diagnosis and treatment. Br Dent J 210(3):113–118

    Article  CAS  Google Scholar 

  23. Costa F, Emanuelli E, Robiony M, Zerman N, Polini F, Politi M (2007) Endoscopic surgical treatment of chronic maxillary sinusitis of dental origin. J Oral Maxillofac Surg 65(2):223–228

    Article  Google Scholar 

  24. Gupta V, Bains BK, Singh GP, Mathur A, Bains R (2011) Regenerative potential of platelet rich fibrin in dentistry: literature review. Asian J Oral Health Allied Sci 1:22–28

    Google Scholar 

  25. Gassling V, Douglas T, Warnke PH, Açil Y, Wiltfang J, Becker ST (2010) Platelet-rich fibrin membranes as scaffolds for periosteal tissue engineering. Clin Oral Implants Res 21:543–549

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Necmettin Erbakan University, Ankara Cd. No: 74A, 42050, Karatay, Konya, Turkey

    Alparslan Esen & Sebnem Akkulah

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  1. Alparslan Esen
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  2. Sebnem Akkulah
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Correspondence to Alparslan Esen.

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Esen, A., Akkulah, S. Management of Large Oroantral Fistulas Caused by Medication-Related Osteonecrosis with the Combined Sequestrectomy, Buccal Fat Pad Flap and Platelet-Rich Fibrin. J. Maxillofac. Oral Surg. 20, 76–82 (2021). https://doi.org/10.1007/s12663-019-01278-x

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  • DOI: https://doi.org/10.1007/s12663-019-01278-x

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