Sinusitis and oroantral fistula in patients with bisphosphonate-associated necrosis of the maxilla
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RESEARCH
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Sinusitis and oroantral fistula in patients with bisphosphonate-associated necrosis of the maxilla Pit Jacob Voss1*, Gustavo Vargas Soto2, Rainer Schmelzeisen1, Kiwako Izumi3, Andres Stricker1, Gido Bittermann1 and Philipp Poxleitner1 Abstract Background: The management of bisphosphonate related necrosis of the jaw has become clinical routine. While approximately two thirds of the lesions are in the mandible, one third is located in the maxilla. In 40–50 % of maxillary necrosis the maxillary sinus is involved, leading to maxillary sinusitis and oro-antral communications. Methods: This retrospective single center study includes all patients with diagnosis of BP-ONJ of the maxilla and concomitant maxillary sinusitis. The information collected includes age, gender, primary disease, bisphosphonate intake, involving type of bisphosphonate, route of administration and duration of BP treatment previous to surgical treatment and treatment outcome. Results: A total of 12 patients fulfill the criteria of the diagnosis of maxillary sinusitis associated to maxillary necrosis, of which 6 Patients showed purulent sinusitis. All patients underwent surgical treatment with complete resection of the affected bone and a multilayer wound closure. A recurrence appeared in one patient with open bone and no sign of sinusitis and was treated conservatively. Conclusions: Purulent maxillary Sinusitis is a common complication of bisphosphonate-related necrosis of the maxilla. The surgical technique described can be suggested for the treatment of these patients. Keywords: Nose and paranasal sinuses, Medication-associated necrosis of the jaws, Zoledronate, Purulent sinusitis
Background Since its first description in 2003, reports of bisphosphonate related osteonecrosis of the jaw (BP-ONJ) accumulate. With the ability to reduce bone turnover through selective inhibition of osteoclasts, Bisphosphonates are used widespread in treatment of osteoporosis and bony metastases of malignant diseases. They are administered orally or intravenously, whereat the bioavailability of oral bisphosphonates is below 1 % [1]. Once circulating in the blood, 70 % are covalently bound to hydroxyapatite in bony tissues, the remainder is secreted via the kidneys. BPs bound to the bone are biologically inert, however, when absorbed by osteoclasts they lead to concentration dependent apoptosis * Correspondence: [email protected] 1 Department of Oral and Maxillofacial Surgery, Regional Plastic Surgery, Medical Center - University of Freiburg , Hugstetter Str. 55, 79106 Freiburg im Breisgau, Germany Full list of author information is available at the end of the article
via inhibition of Farnesyl-Pyrophosphate-synthase [2]. Being integrated only during bone turnover, concentration is suspected to be higher in areas of high turnover such as the alveolar processes [3]. Due to local factors like chewing forces, oral bacteria, the periodontal gap and a thin mucosa, the alveolar bone necessitates an elevated osteoclast-dependent bone turnove
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