BISPHOSPHONATE-ASSOCIATED OSTEONECROSIS OF THE JAWS: THE LIMITS OF A CONSERVATIVE APPROACH

Abstract: Background. An increasing number of cases ofosteonecrosis of the jaws (ONJ) in patients treated withbisphosphonates has been reported in the literature. ONJ sig-nificantly affects the patients’ quality of life and its manage-ment is still extremely difficult.Methods. A woman with ONJ secondary to therapy withzoledronic acid came to our attention for recurrent oral infec-tions and orocutaneous fistula unresponsive to antibiotic ther-apy combined with minor surgical debridements. The patientunderwent major surgery to remove the fistula and clean thenecrotic bone and soft tissues; a lobed skin platysma flap wasused to close the defect. The treatment outcome was good.Conclusion. When ONJ fails to respond to antibiotic ther-apy and surgical debridements, a more invasive surgicalapproach may be necessary to guarantee a better quality oflife for the patient. VV C 2009 Wiley Periodicals, Inc. Head Neck31: 1249–1254, 2009Keywords: bisphosphonates; osteonecrosis; jaw; osteonecrosisof the jaws; mandibular surgery