gms | German Medical Science

131. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

25.03. - 28.03.2014, Berlin

Bisphosphonate-associated osteonecrosis – most frequent osteopathy in craniomaxillofcial surgery 10 years later

Meeting Abstract

Suche in Medline nach

  • Waldemar Reich - Universitätsklinikum Halle, Universitätsklinik und Poliklinik für Mund-, Kiefer- und Plastische Gesichtschirurgie, Halle
  • Maria Barchmann - Universitätsklinikum Halle, Universitätsklinik und Poliklinik für Mund-, Kiefer- und Plastische Gesichtschirurgie, Halle
  • Alexander Eckert - Universitätsklinikum Halle, Universitätsklinik und Poliklinik für Mund-, Kiefer- und Plastische Gesichtschirurgie, Halle

Deutsche Gesellschaft für Chirurgie. 131. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 25.-28.03.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc14dgch321

doi: 10.3205/14dgch321, urn:nbn:de:0183-14dgch3216

Veröffentlicht: 21. März 2014

© 2014 Reich et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: Over one hundred years upon the first synthesis of the geminal bisphosphonate (BP) by von Baeyer und Hoffmann (1897) and one decade (2003) since the initial report on the bisphosphonate-related of osteonecrosis of the jaw (ONJ) this osteopathy remains a serious clinical challenge. In the mean time occuring just more frequently than osteoradionecrosis of the facial skeleton.

Material and methods: In a monocentric study over the period of 2005 to 2013 all inpatients with manifestation of ONJ were prospectively included. The recorded data were the medical history, comorbidity, BP-treatment, risk factors, ONJ-localization and treatment, imaging and histomorphological features as well as complicatoins.

Results: 63 patients with an average age of 68,9 years were evaluated (32 male, 31 female).

Prostate and breast cancer (n=10, n=22) respectively multiple myeloma (n=13) were the three most frequent malignancies; and cardiovascular diseases, diabetes mellitus as well as nephrological disorders were the most important comorbidities. In 66,7% of all patients zoledronate was associated with the ONJ. The average duration of BP-treatment was found to be 38±28 months. The severity of the ONJ (stage II and stage III according to AAOMS 2009) was found to be equally distributed (pathological mandibular fractures n=3, sinusitis maxillaris n=3) beeing prodominantly localised in the mandibula (Figure 1 [Fig. 1]). Thus, needing resections in 13 cases with following defect configurations (Boyd et al. 1993): L-Defect n=10, H-Defect n=1, C-Defect n=1, LL-Defect n=1), which presents the most difficult conditions.The histological aspect of ONJ shows a chronical granulary but predominantly suppurative inflammation with osteonecrosis including Actinomyces species.

Conclusion: The current comprehensive knowledge about pathogenesis of ONJ reveales:

  • reduction of the osteocyte count
  • antiangiogenesis
  • reduced proliferation und migration capacity of epithelial cells
  • osteosclerosis
  • disturbed mucosal or gingival integrity
  • prolonged wound healing
  • disturbed bone remodeling
  • biofilm (Yoneda et al. 2010, Landesberg 2011).

With the focus on identification of risk factors, early recognition and better treatment of ONJ a multidisciplinary approach is essential.