Abstract
Osteonecrosis of the jaw (ONJ) is a disease that affects the jaw. It is mainly related to radiation or bisphosphonates therapy, and the symptoms and signs consist of pain, bone exposure, inflammation of the surrounding soft tissue swelling, and secondary infection or drainage. In the case of advanced disease of the mandibular area, the treatment of choice is mandibular resection and reconstruction. In the present study, we report a case series of patients affected by ONJ and treated with a customised bridging mandibular prosthesis-only technique. From 2016 to 2018, we treated five consecutive patients affected by ONJ: three patients were affected by biphosphonate-related osteonecrosis of the mandible (BRONJ) and two were affected by osteoradionecrosis of the mandible (ORNJ). Three patients needed a soft tissue free flap to permit optimal wound closure, intra- and/or extraorally. All reconstructive procedures were carried out successfully, with no major or minor microvascular complication. The average postoperative follow-up was 24.8 (range 10–41) months. Considering that microvascular bone transfer is a high-risk procedure in BRONJ patients, we can conclude that the positioning of a customised bridging mandibular prosthesis (CBMP), whether or not associated with a microvascular soft tissue transfer, is a safe technique in terms of surgical outcome and feasibility.
Highlights
Osteonecrosis of the jaw (ONJ) is a disease causing a series of symptoms such as pain, bone exposure, inflammation of the surrounding soft tissue, swelling, and secondary infection or drainage (Figure 1)
Three patients were treated with a customised bridging mandibular prosthesis (CBMP) after the rupture or misplacement of a standard plate; two patients were treated as a result of previous surgical treatment without the positioning of a plate
In 1983, Marx had already explained the pathophysiology of ORNJ, using the “3H” principle to describe the effect of radiation on the tissue [1], and, in 2003, was the first to describe some cases of MRONJ induced by bisphosphonates [2]
Summary
Osteonecrosis of the jaw (ONJ) is a disease causing a series of symptoms such as pain, bone exposure, inflammation of the surrounding soft tissue, swelling, and secondary infection or drainage (Figure 1). Various forms of ONJ have been described over the last few years, and a number of causes have been suggested in the literature, being frequently associated with cancer treatments (including radiation, ORNJ) and antiresorptive medications used for bone metastasis or osteoporosis (MRONJ). In 1983, explains the pathophysiology of ORNJ using the “3H” principle (hypocellular, hypovascular, and hypoxic tissues) to describe the effect of radiation on the tissue [1] and, in 2003, was the first to describe some cases of MRONJ induced by bisphosphonates [2] (BRONJ), correlated to and increasing trabecular bone density, inducing vascular insufficiency, and causing bone necrosis [3].
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