Osteonecrosis of the jaw surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

In cases of advanced oral ischemic osteoporosis and/or ONJ that are not bisphosphonates related, clinical evidence has shown that surgically removing the damaged marrow, usually by curettage and decortication, will eliminate the problem (and the pain) in 74% of patients with jaw involvement.[1] Repeat surgeries, usually smaller procedures than the first, may be required, and almost a third of jawbone patients will need surgery in one or more other parts of the jaws because the disease so frequently present multiple lesions, i.e. multiple sites in the same or similar bones, with normal marrow in between. In patients with bisphosphonates-associated ONJ, the response to surgical treatment is usually poor.[2] Conservative debridement of necrotic bone, pain control, infection management, use of antimicrobial oral rinses, and withdrawal of bisphosphonates are preferable to aggressive surgical measures for treating this form of ONJ.

Surgery

Staging and Recommended Management[3]

Stage Recommended Management
Stage 0 Antibiotic treatment and pain management
Stage 1 Patient education, antibiotic mouth rinse, consider discontinuing biphosmonate therapy
Stage 2 Debridement, oral antibiotic therapy plus antibiotic mouth rinse and pain management
Stage 3 Debridement or resection for better infection control, oral antibiotic therapy plus antibiotic mouth rinse and pain management

References

  1. Bouquot JE, Christian J. Long-term effects of jawbone curettage on the pain of facial neuralgia. J Oral Maxillofac Surg 1995; 53:387-397.
  2. Zarychanski R, Elphee E, Walton P, Johnston J. Osteonecrosis of the jaw associated with pamidronate therapy. Am J Hematol. 2006 Jan;81(1):73-5.
  3. "http://www.aaoms.org/docs/position_papers/mronj_position_paper.pdf?pdf=MRONJ-Position-Paper" (PDF). External link in |title= (help)

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