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Osteonecrosis

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Evidence-Based Oral Surgery

Abstract

This chapter explores three different, yet interrelated, topics essential for the practice of oral and maxillofacial surgery. It addresses the current evidence-based treatment recommendations for osteomyelitis, medication-related osteonecrosis of the jaw (MRONJ), and osteoradionecrosis (ORN). Additionally, this chapter addresses the etiology, diagnosis, and staging of MRONJ/BRONJ and ORN, as well as the subcategories of osteomyelitis of the jaws, including acute suppurative osteomyelitis, chronic suppurative osteomyelitis, chronic sclerosing osteomyelitis, and juvenile mandibular chronic osteomyelitis (JMCO).

I remain an unknown factor in the business, ready to throw in all my weight at a critical moment.

—The Hound of the Baskervilles

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References

  • Assael LA. Bisphonsphonates and oral health: primer and an update for the practicing surgeon. Oral Maxillofac Surg Clin North Am. 2011;23:443–53.

    Article  PubMed  Google Scholar 

  • Bagheri S, Girn J, Jo C. Clinical review of oral and maxillofacial surgery. Mosby: Elsevier; 2008. p. 85–8.

    Google Scholar 

  • Beuselinck B, Wolter P, Karadimou A, et al. Concomitant oral tyrosine kinase inhibitors and bisphosphonates in advanced renal cell carcinoma with bone metastases. Br J Cancer. 2012;107:1665.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bevin CR, Inwards CY, Keller EE. Surgical management of primary chronic osteomyelitis: a long-term retrospective analysis. J Oral Maxillofac Surg. 2008;66:2073–85.

    Article  PubMed  Google Scholar 

  • Bruins HH, Koole R, Jolly DE, et al. Pretherapy dental decisions in patients with head and neck cancer. A proposed model for dental decision support. Oral Surg Oral Med Pathol Oral Radiol Endod. 1998;86:256–67.

    Article  Google Scholar 

  • Carlson ER, Basile JD. The role of surgical resection in the management of bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg. 2009;67(5, Suppl. 1):85–95.

    Article  PubMed  Google Scholar 

  • Ceponis P, Keilman C, Guerry C, Freiberger JJ. Hyperbaric oxygen therapy and osteonecrosis. Oral Dis. 2017;23(2):141–51.

    Article  PubMed  Google Scholar 

  • Chiandussi S, Biasotto M, Dore F, Cavalli F, Cova MA, Di Lenarda R. Clinical and diagnostic imaging of bisphosphonate-associated osteonecrosis of the jaws. Dentomaxillofac Radiol. 2006;35:236–43.

    Article  PubMed  Google Scholar 

  • Delanian S, Depondt J, Lefaix JL. Major healing of refractory mandible osteoradionecrosis after treatment combining pentoxifylline and tocopherol: a phase II trial. Head Neck. 2005;27:114–23.

    Article  PubMed  Google Scholar 

  • Dimopoulos MA, Kastritis E, Bamia C, et al. Reduction of osteonecrosis of the jaw (ONJ) after implementation of preventive measures in patients with multiple myeloma treated with zoledronic acid. Ann Oncol. 2009;20(1):117–20.

    Article  PubMed  Google Scholar 

  • Dodson TB. The frequency of medication-related osteonecrosis of the jaw and its associated risk factors. Oral Maxillofac Surg Clin North Am. 2015;27:509–16.

    Article  PubMed  Google Scholar 

  • Dym H, Zeidan J. Microbiology of acute and chronic osteomyelitis and antibiotic treatment. Dent Clin N Am. 2017;61:271–82.

    Article  PubMed  Google Scholar 

  • Ecury-Goossen M, Huysman A, Verhallen-Dantuma CTM, et al. Sequential intravenous-oral antibiotic therapy for neonatal osteomyelitis. Pediatr Infect Dis J. 2009;28(1):72–3.

    Article  Google Scholar 

  • Fliefel R, Troltzsch M, Kuhnisch J, Ehrenfeld M, Otto S. Treatment strategies and outcomes of bisphosphonate-related osteonecrosis of the jaw [BRONJ] with characterization of patients: a systematic review. Int J Oral Maxillofac Surg. 2015;44:568–85.

    Article  PubMed  Google Scholar 

  • Goodday RH. Preventive strategies of patients at risk of medication-related osteonecrosis of the jaw. Oral Maxillofac Surg Clin North Am. 2015;27:527–36.

    Article  PubMed  Google Scholar 

  • He Y, Liu Z, Tian T, et al. Retrospective analysis of osteoradionecrosis of the mandible: proposing a novel clinical classification and staging system. Int J Oral Maxillofac Surg. 2015;44:1547–57.

    Article  PubMed  Google Scholar 

  • Helm C, et al. Management of acute osteomyelitis: a ten-year experience. Infect Dis Rep. 2016;8(3):63–7.

    Article  Google Scholar 

  • Hinson AM, Smith CW, Siegel ER, et al. Is bisphosphonate-related osteonecrosis of the jaw an infection? A histological and microbiological ten-year summary. Int J Dent. 2014;2014:452737.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hjorting-Hansen E. Decortication in treatment of osteomyelitis of the mandible. Oral Surg Oral Med Oral Pathol. 1970;29(5):641–55.

    Article  PubMed  Google Scholar 

  • Holzinger D, Seemann R, Klug C, et al. Long-term success of surgery in bisphosphonate-related osteonecrosis of the jaws [BRONJs]. Oral Oncol. 2013;49:66–70.

    Article  PubMed  Google Scholar 

  • Hudson JW. Osteomyelitis of the jaws: a 50-year perspective. J Oral Maxillofac Surg. 1993;51(12):1294–301.

    Article  PubMed  Google Scholar 

  • Jacobsson S. Discussion: isolation of Actinomyces species and Eikenella Corrodens from patients with chronic diffuse sclerosing osteomyelitis. J Oral Maxillofac Surg. 1994;52:33–4.

    Article  Google Scholar 

  • Kim KM, et al. Distinctive role of 6-month teriparatide treatment on intractable bisphosphonate-related osteonecrosis of the jaw. Osteoporos Int. 2014;25:1625–32.

    Article  PubMed  Google Scholar 

  • Kim HY, et al. Extensive surgical procedures result in better treatment outcomes for bisphosphonate-related osteonecrosis of the jaw in patients with osteoporosis. J Oral Maxillofac Surg. 2017;75:1404–13.

    Article  PubMed  Google Scholar 

  • Kluth E, Jain PR, Stuchell RN, et al. A study of factors contributing to the development of osteora- dionecrosis of the jaws. J Prosthet Dent. 1988;59(2):194–201.

    Article  PubMed  Google Scholar 

  • Kojima Y, Yanamoto S, Umeda M, et al. Relationship between dental status and development of osteoradionecrosis of the jaw: a multi center retrospective study. J Oral Maxillofac Surg. 2007;124(2):139–45.

    Google Scholar 

  • Koorbusch GF, Deatherage JR. How can we diagnose and treat osteomyelitis of the jaws as early as possible? Oral Maxillofac Surg Clin North Am. 2011;23:557–67.

    Article  PubMed  Google Scholar 

  • Koorbusch GF, Fotos P, Terhark-Goll K. Retrospective assessment of osteomyelitis: etiology, demo- graphics, risk factors, and management in 35 cases. Oral Surg Oral Med Oral Pathol. 1992;74(2):149–54.

    Article  PubMed  Google Scholar 

  • Krakowiak PA. Alveolar osteitis and osteomyelitis of the jaws. Oral Maxillofac Surg Clin North Am. 2011;23:401–13.

    Article  PubMed  Google Scholar 

  • Kumar SK, Gorur A, Schaudinn C, et al. The role of microbial biofilms in osteonecrosis of the jaw associated with bisphosphonate therapy. Curr Osteoporos Rep. 2010;8(1):40–8.

    Article  PubMed  Google Scholar 

  • Kyrgidis A, Toulis KA. Denosumab-related osteonecrosis of the jaws. Osteoporos Int. 2011;22(1):369–70.

    Article  PubMed  Google Scholar 

  • Kyrgidis A, Vahtsevanos K, Koloutsos G, et al. Bisphosphonate-related osteonecrosis of the jaws: a case-control study of risk factors in breast cancer patients. J Clin Oncol. 2008;26:4634.

    Article  PubMed  Google Scholar 

  • Kyrgidis A, Koloutsos G, Vahtsevanos K. Treatment protocols of bisphosphonate-related osteonecrosis of the jaws. Head Neck. 2009;31(8):1112–3. [author reply 1113–4]

    Article  PubMed  Google Scholar 

  • Landesberg R, Woo V, Cremers S, et al. Potential pathophysiological mechanisms in osteonecrosis of the jaw. Ann N Y Acad Sci. 2011;1218:62–79.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lee IJ, Woong SK, Chang GL, et al. Risk factors and dose-effect relationship for mandibular osteoradionecrosis in oral and oropharyngeal cancer. Int J Radiat Oncol Biol Phys. 2009;75(4):1084–91.

    Article  PubMed  Google Scholar 

  • Lo JC, O’Ryan FS, Gordon NP, et al. Prevalence of osteonecrosis of the jaw in patients with oral bisphosphonate exposure. J Oral Maxillofac Surg. 2010;68:243.

    Article  PubMed  Google Scholar 

  • Lyons A, Ghazali N. Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment. Br J Oral Maxillofac Surg. 2008;46(8):653–60.

    Article  PubMed  Google Scholar 

  • Marx R. Osteoradionecrosis: a new concept in its pathophysiology. J Oral Maxillofac Surg. 1983;41:283–8.

    Article  PubMed  Google Scholar 

  • Marx RE. Pamidronate [Aredia] and Zolendronate [Zometa] induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg. 2003;61:1115–8.

    Article  PubMed  Google Scholar 

  • Marx RE, Carlson ER, Smith BR, Toraya N. Isolation of actinomyces species and Eikenella corrodens from patients with chronic diffuse sclerosing osteomyelitis. J Oral Maxillofac Surg. 1994;52:26–33.

    Article  PubMed  Google Scholar 

  • Moon DH, Moon SH, et al. Incidence of, and risk factors for, mandibular osteoradionecrosis in patient with oral cavity and oropharynx cancers. Oral Oncol. 2017;72:98–103.

    Article  PubMed  Google Scholar 

  • Neto T, et al. Resection and microvascular reconstruction of bisphosphonate-related osteonecrosis of the jaw: The role of microvascular reconstruction. Head Neck. 2016;38(8):1278–85.

    Article  PubMed  Google Scholar 

  • Neville BW. Oral and maxillofacial pathology. St. Louis, MO: Saunders; 2009. p. 141–50.

    Google Scholar 

  • O’Dell K, Sinha U. Osteoradionecrosis. Oral Maxillofac Surg Clin North Am. 2011;23:455–64.

    Article  PubMed  Google Scholar 

  • Owosho AA, Kadempour A, Yom SK, et al. Radiographic osteoradionecrosis of the jaw with intact mucosa: proposal of clinical guideline for early identification of this condition. Oral Oncol. 2015;15(12):e93–6.

    Article  Google Scholar 

  • Qi W, et al. Risk of osteonecrosis of the jaw in cancer patients receiving denosumab: a meta-analysis of seven randomized controlled trials. Int J Clin Oncol. 2014;19:403–10.

    Article  PubMed  Google Scholar 

  • Renapurkar S, Pasternack M, Nielsen PG, Kaban LB. Juvenile mandibular chronic osteomyelitis: role of surgical debridement and antibiotics. J Oral Maxillofac Surg. 2015;73(9):e41–2.

    Article  Google Scholar 

  • Ruggerio SL. Diagnosis and staging of medication-related osteonecrosis of the jaw. Oral Maxillofac Surg Clin North Am. 2015;27:479–87.

    Article  Google Scholar 

  • Ruggiero SL, Mehrotra B, Rosenberg TJ, et al. Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg. 2004;62(5):527–34.

    Article  PubMed  Google Scholar 

  • Ruggiero SL, Dodson TB, Fantasia J, et al. American association of oral and maxillofacial surgeons position paper on medication-related osteonecrosis of the jaw–2014 update. J Oral Maxillofac Surg. 2014;72(10):1938–56.

    Article  PubMed  Google Scholar 

  • Sammut S, et al. Juvenile chronic mandibular osteomyelitis: a case series defining the clinico-pathological features of this rare condition. Br J Oral Maxillofac Surg. 2014;52(8):e43–74.

    Google Scholar 

  • Santosh ABR, Ogle OE, Williams D, Woodbine EF. Epidemiology of Oral and Maxillofacial Infections. Oral Maxillofac Surg Clin North Am. 2017;61:217–33.

    Google Scholar 

  • Schneider LC, Mesa ML. Differences between florid osseous dysplasia and chronic diffuse sclerosing osteomyelitis. Oral Surg Oral Med Pathol. 1990;70:308–12.

    Article  Google Scholar 

  • Schuknecht B, Valavanis A. Osteomyelitis of the mandible. Neuroimaging Clin N Am. 2003;13:605–18.

    Article  PubMed  Google Scholar 

  • Schulze D, Blessman M, Pohlenz P, Wagner KW, Heiland M. Diagnostic criteria for the detection of mandibular osteomyelitis using cone-beam computed tomography. Dentomaxillofac Radiol. 2006;35:232–5.

    Article  PubMed  Google Scholar 

  • Schwartz HC, Kagan AR. Osteoradionecrosis of the mandible. Am J Clin Oncol. 2002;25(2):168–71.

    Article  PubMed  Google Scholar 

  • Scoletta M, et al. Tooth extractions in intravenous bisphosphonate-treated patients: a refined protocol. J Oral Maxillofac Surg. 2013;71:994–9.

    Article  PubMed  Google Scholar 

  • Shintani T, et al. Comparison of the prognosis of bisphosphonate-related osteonecrosis of the jaw caused by oral ind intravenous bisphosphonates. Int J Oral Maxillofac Surg. 2015;44:840–4.

    Article  PubMed  Google Scholar 

  • Spanou A, et al. Management of bisphosphonate-related osteonecrosis of the jaw: a literature review. Oral Dis. 2015;21:927–36.

    Article  PubMed  Google Scholar 

  • Tsao C, et al. Oral health risk factors for bisphosphonate-associated jaw osteonecrosis. J Oral Maxillofac Surg. 2013;71:1360–6.

    Article  PubMed  Google Scholar 

  • Vahtsevanos K, Kyrgidis A, Verrou E, et al. Longitudinal cohort study of risk factors in cancer patients of bisphosphonate-related osteonecrosis of the jaw. J Clin Oncol. 2009;27:5356–62.

    Article  PubMed  Google Scholar 

  • Van Merkesteyn JPR, et al. Hyperbaric oxygen treatment of chronic osteomyelitis of the jaws. Int J Oral Surg. 1984;13:386–95.

    Article  PubMed  Google Scholar 

  • Vandone AM, Donadio M, Mozzati M, et al. Impact of dental care in the prevention of bisphosphonate-associated osteonecrosis of the jaw: a single-center clinical experience. Ann Oncol. 2012;23:193.

    Article  PubMed  Google Scholar 

  • Vercruysse H Jr, Backer TD, Mommaerts MY. Outcomes of osseous free flap reconstruction in stage III bisphosphonate-related osteonecrosis of the jaw: systematic review and a new case series. J Craniomaxillofac Surg. 2014;42:377–86.

    Article  PubMed  Google Scholar 

  • Williams WB. Management of medication-related osteonecrosis of the jaw. Oral Maxillofac Surg Clin North Am. 2015;27:517–25.

    Article  PubMed  Google Scholar 

  • Wong JK, Wood RE, McLean M. Conservative management of osteoradionecrosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;84:16.

    Article  PubMed  Google Scholar 

  • Yamazaki T, Yamori M, Ishizaki T, et al. Increased incidence of osteonecrosis of the jaw after tooth extraction in patients treated with bisphosphonates: a cohort study. Int J Oral Maxillofac Surg. 2012;41:1397.

    Article  PubMed  Google Scholar 

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Hauer, J.M., Banki, M., Ferneini, E.M. (2019). Osteonecrosis. In: Ferneini, E., Goupil, M. (eds) Evidence-Based Oral Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-91361-2_14

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  • DOI: https://doi.org/10.1007/978-3-319-91361-2_14

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