gms | German Medical Science

50. Jahrestagung der Deutschen Gesellschaft für Plastische und Wiederherstellungschirurgie (DGPW)

Deutsche Gesellschaft für Plastische und Wiederherstellungschirurgie e. V.

11.10.-13.10.2012, Hannover

Mandibular Fracture in Patients with Osteogenesis Imperfecta treated with Bisphosphonates – A Case Study

Meeting Abstract

  • F. Mascha - Ulm
  • F. Wilde - Ulm
  • M. Heufelder - Ulm
  • S. Pietzka - Ulm
  • A. Schramm - Ulm

Deutsche Gesellschaft für Plastische und Wiederherstellungschirurgie. 50. Jahrestagung der Deutschen Gesellschaft für Plastische und Wiederherstellungschirurgie (DGPW). Hannover, 11.-13.10.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12dgpw30

doi: 10.3205/12dgpw30, urn:nbn:de:0183-12dgpw308

Published: December 4, 2012

© 2012 Mascha et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Introduction: Patients with Osteogenesis Imperfecta (OI) suffer from severe fracturing due to minor injuries. Even the facial bones are frequently affected. As a medicinal basis, Bisphosphonate is administered intravenously to prevent fracturing. This procedure is standard in cases of Osteogenesis Imperfecta. It results not only in an increase in bone density but also in a significant decrease in the rate of fracture. Osteonecrosis of the lower jaw has been described as a major complication of this treatment. However, a retrospective study, as well as numerous clinical case studies, have already shown that OI-patients with Bisphosphonate treatment have not suffered from the aforementioned complications after dentoalveolar surgery. However, further research on this topic is needed.

Methods: The following describes the case of a 16-year-old patient with multiple fractures in the lower jaw incurred in a bicycle accident. The patient suffers from Osteogenesis Imperfecta, resulting in recurrent fractures in the extremities. In the previous two years, Bisphosphonate (Pamidron-acid) was administered intravenously as the basis medication. We decided upon operative care of the patient by means of monocortical miniplate osteosynthesis, exclusively through an oral approach. Preoperatively, a temporary intermaxillary fixation via screws with a local anesthetic was implemented. During and after the operation, antibiotics were administered intravenously to the patient.

Results: Intraoperatively, the implantation of the ostesynthetic screws proved to be very difficult due to reduced bone quality. Postoperative procedure proved itself to be without complication. In regular check-ups during one year after operative care, the patient showed neither signs of discomfort nor indications of the existence of BP-ONJ. The removal of the implants has not yet been considered.

Conclusion: This report shows that mandibular fracturing in patients with OI and the simultaneous exposition of Bisphosphonate can be sufficiently treated using orally inserted monocortical miniplate osteosynthesis. It remains to be seen whether or not one can determine the risk of BP-ONJ in such patients. We recommend a maxium measure of care regarding intraoperative suturing and postoperative procedures.