Suppl.completo reimpag._4b_. 04/10/13 15:55 Pagina 18
Case Report
Conservative surgical treatment in the management of BRONJ: a case series of 129 consecutive cases M. Gabriele, F. La Ferla, S. Cei, M. Nisi, F. Graziani Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Italy Aim. Aim of this case series was to evaluate the out comes of conservative surgical treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Materials. 119 subjects affected by 129 BRONJ and surgically treated in our unit were enrolled. Surgical treatment (sequestrectomy, soft tissue debridement, and bone curettage with no or limited extension) was delivered only to sites that did not respond to medical treatment. Age, gender, underlying disease, tabagism, comorbidity were also analysed. Main outcome was improvement of clinical stage and disease resolution (passage to stage 0). Subjects were followed for at least 6 months. Results. Sample: oncologic diagnoses was made in most of the cases (77%). Breast cancer was the primary pathology (36 subjects, 30%), followed by multiple myeloma (26 subjects). Sixty-three percent of the lesions were located in the mandible (81 subjects). The main event leading to BRONJ was tooth extraction (76 subjects, 59%). A reasonable explanation for BRONJ was detected in 82%. The most frequent stage of BRONJ was stage II (77 subject, 60%), whereas stage I (26 subject, 20%) and stage III (26 subject, 20%) were less common. Effect of surgical treatment: during follow-up, one subject died. 84% of subjects showed improvement after surgery, 15% showed no modification, and 1% exhibited a worsening of their clinical condition. Stratification indicated improvement for 100% stage I ( and therefore total disease resolution), 87% stage II and 52% stage III. Disease resolution was noted in the 75% of Stage II and 40% of Stage III. Interestingly, a learning surgical curve was effect noted for disease resolution. Conclusion. Our data suggest that conservative surgery may be the possible treatment of choice in stage I and II. Conversely, stage III subjects might be treated with either a resective surgical approach or clinical monitoring according to the clinical medical scenario of the patient. References •
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Graziani F, Vescovi P, Campisi G, Favia G, Gabriele M, Gaeta GM, Gennai S, Goia F, Miccoli M, Peluso F, Scoletta M, Solazzo L, Colella G. Resective surgical approach shows a high performance in the management of advanced cases of bisphosphonate-related osteonecrosis of the jaws: a retrospective survey of 347 cases. J Oral Maxillofac Surg 2012 Nov; 70(11):2501-7. Graziani F, Cei S, La Ferla F, Cerri E, Itro A, Gabriele M. Association between osteonecrosis of the jaws and chronic highdosage intravenous bisphosphonates therapy. J Craniofac Surg 2006 Sep; 17(5):876-9. Holzinger D, Seemann R, Klug C, Ewers R, Millesi G, Baumann A, Wutzl A. Long-term success of surgery in bisphosphonaterelated osteonecrosis of the jaws (BRONJs). Oral Oncol 2013 Jan; 49(1):66-70.
Annali di Stomatologia 2013; Suppl. 2: 1-48
Case Report
Conservative surgical treatment in the management of BRONJ: a case series of 129 consecutive cases M. Gabriele, F. La Ferla, S. Cei, M. Nisi, F. Graziani Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Italy Aim. Aim of this case series was to evaluate the out comes of conservative surgical treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Materials. 119 subjects affected by 129 BRONJ and surgically treated in our unit were enrolled. Surgical treatment (sequestrectomy, soft tissue debridement, and bone curettage with no or limited extension) was delivered only to sites that did not respond to medical treatment. Age, gender, underlying disease, tabagism, comorbidity were also analysed. Main outcome was improvement of clinical stage and disease resolution (passage to stage 0). Subjects were followed for at least 6 months. Results. Sample: oncologic diagnoses was made in most of the cases (77%). Breast cancer was the primary pathology (36 subjects, 30%), followed by multiple myeloma (26 subjects). Sixty-three percent of the lesions were located in the mandible (81 subjects). The main event leading to BRONJ was tooth extraction (76 subjects, 59%). A reasonable explanation for BRONJ was detected in 82%. The most frequent stage of BRONJ was stage II (77 subject, 60%), whereas stage I (26 subject, 20%) and stage III (26 subject, 20%) were less common. Effect of surgical treatment: during follow-up, one subject died. 84% of subjects showed improvement after surgery, 15% showed no modification, and 1% exhibited a worsening of their clinical condition. Stratification indicated improvement for 100% stage I ( and therefore total disease resolution), 87% stage II and 52% stage III. Disease resolution was noted in the 75% of Stage II and 40% of Stage III. Interestingly, a learning surgical curve was effect noted for disease resolution. Conclusion. Our data suggest that conservative surgery may be the possible treatment of choice in stage I and II. Conversely, stage III subjects might be treated with either a resective surgical approach or clinical monitoring according to the clinical medical scenario of the patient. References •
• •
18
Graziani F, Vescovi P, Campisi G, Favia G, Gabriele M, Gaeta GM, Gennai S, Goia F, Miccoli M, Peluso F, Scoletta M, Solazzo L, Colella G. Resective surgical approach shows a high performance in the management of advanced cases of bisphosphonate-related osteonecrosis of the jaws: a retrospective survey of 347 cases. J Oral Maxillofac Surg 2012 Nov; 70(11):2501-7. Graziani F, Cei S, La Ferla F, Cerri E, Itro A, Gabriele M. Association between osteonecrosis of the jaws and chronic highdosage intravenous bisphosphonates therapy. J Craniofac Surg 2006 Sep; 17(5):876-9. Holzinger D, Seemann R, Klug C, Ewers R, Millesi G, Baumann A, Wutzl A. Long-term success of surgery in bisphosphonaterelated osteonecrosis of the jaws (BRONJs). Oral Oncol 2013 Jan; 49(1):66-70.
Annali di Stomatologia 2013; Suppl. 2: 1-48
