A Technique for the Treatment of Oral-Antral Fistulae Resulting from Medication-Related Osteonecrosis of the Maxilla: The Combined Buccal Fat Pad Flap and Radical Sinusotomy

Publication date: Available online 31 March 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): James C. Melville, Ramzey Tursun, Jonathan W. Shum, Simon Young, Issa A. Hanna, Robert E. Marx
ObjectiveBisphosphonates and monoclonal antibodies directed at osteoclastic function are frequently used to treat postmenopausal and corticosteroid induced osteoporosis. They are also used in the treatment of certain metastatic malignancies. However osteonecrosis of the jaw has been reported following intravenous, subcutaneous or oral use.1 More than 12 million Americans and another 20 million are thought to be taking a bisphosphonate worldwide.2 Increasingly exposed bone with oral-antral fistulae has been known to occur as a specific presentation of what is now termed as medication related osteonecrosis of the jaws with a specific ICD-10 code.3 Oral-antral communications caused by Bisphosphonate concomitant with a secondary sinusitis represents a unique treatment challenge for the oral and maxillofacial surgeon. The purpose of this article is to demonstrate a simple but effective technique to treat oral-antral communications caused by MRONJ.Study DesignWith the review and approval of the University of Miami IRB, we identified 23 patients who underwent this surgical procedure.ResultsWe report a 100% resolution of the ONJ and sinusitis with re-pneumatization.ConclusionsThe buccal fat pad and radical sinustomy can be used as an effective and predictable technique for the resolution of Oral-antral fistulas due to MRONJ



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