Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Journal of Maxillofacial and Oral Surgery
Published in: Journal of Maxillofacial and Oral Surgery 1/2021

01-03-2021 | Sinus Surgery | Original Article

Management of Large Oroantral Fistulas Caused by Medication-Related Osteonecrosis with the Combined Sequestrectomy, Buccal Fat Pad Flap and Platelet-Rich Fibrin

Authors: Alparslan Esen, Sebnem Akkulah

Published in: Journal of Maxillofacial and Oral Surgery | Issue 1/2021

Login to get access

Abstract

Purpose

The aim of this retrospective study was to describe the efficacy of management of bisphosphonate-related maxillary osteonecrosis, which had resulted in an oroantral fistula formation, by performing sequestrectomy, platelet-rich fibrin (PRF) and buccal fat pad (BFP) flap.

Patient and Methods

A total of 7 patients diagnosed with stage III maxillary medication-related osteonecrosis according to guidelines of the American Association of Oral and Maxillofacial Surgeons. All patients complained of persistent pain, swelling and purulent drainage with sinusitis. In order to keep the infection under control, the patients first received an antibiotic combination for 2 weeks. Then, sequestrectomy and bone debridement were performed under general anesthesia. After that, an antrectomy was performed via endoscopic sinus surgery in some cases. And the fistula was closed with BFP after or before the PRF application to the region depending on the size of the fistula.

Results

The fistula was successfully closed. After a mean follow-up of 16 months, no symptoms were seen in the patients.

Conclusions

The patients were successfully managed with a combined treatment consisted of sequestrectomy, PRF and BFP. We suggest that large defects arose from medication-related osteonecrosis of the jaw can be managed with such a combined approach in order to lessen the recurrence risk.
Literature
1.
Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Agbaloo T, Mebrotra B, O’Ryan F (2014) American Association of oral and maxillofacial surgeons position paper on medication-related osteonecrosis of the jaw—2014 update. J Oral Maxillofac Surg 72(10):1938–1956CrossRef
2.
Bamias A, Kastritis E, Bamia C, Moulopoulos LA, Melakopoulos I, Bozas G, Koutsoukou V, Gika D, Anagnostopoulos A, Papadimitriou C, Terpos E, Dimopoulos M (2005) Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: incidence and risk factors. J Clin Oncol 23(34):8580–8587CrossRef
3.
Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL (2004) Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg 62(5):527–534CrossRef
4.
Mast G, Otto S, Mucke T, Schreyer C, Bissinger O, Kolk A, Wolff KD, Ehrenfeld M, Stürzenbaum SR, Pautke C (2012) Incidence of maxillary sinusitis and oro-antral fistulae in bisphosphonate-related osteonecrosis of the jaw. J Craniomaxillofac Surg 40(7):568–571CrossRef
5.
Maurer P, Sandulescu T, Kriwalsky MS, Rashad A, Hollstein S, Stricker I, Hölzle F, Kunkel M (2011) Bisphosphonate-related osteonecrosis of the maxilla and sinusitis maxillaris. Int J Oral Maxillofac Surg 40(3):285–291CrossRef
6.
Dolanmaz D, Tuz H, Bayraktar S, Metin M, Erdem E, Baykul T (2004) Use of pedicled buccal fat pad in the closure of oroantral communication: analysis of 75 cases. Quintessence 35(3):241–246
7.
Egyedi P (1977) Utilization of the buccal fat pad for closure of oro-antral and/or oro-nasal communications. J Maxillofac Surg 5(4):241–244CrossRef
8.
Poeschl PW, Baumann A, Russmueller G, Poeschl E, Klug C, Ewers R (2009) Closure of oroantral communications with Bichat’s buccal fat pad. J Oral Maxillofac Surg 67(7):1460–1466CrossRef
9.
Gallego L, Junquera L, Pelaz A, Hernando J, Megias J (2012) The use of pedicled buccal fat pad combined with sequestrectomy in bisphosphonate-related osteonecrosis of the maxilla. Med Oral Patol Oral Cir Bucal 17(2):e236–e241CrossRef
10.
Rotaru H, Kim MK, Kim SG, Park YW (2015) Pedicled buccal fat pad flap as a reliable surgical strategy for the treatment of medication-related osteonecrosis of the jaw. J Oral Maxillofac Surg 73(3):437–442CrossRef
11.
Roy S, Driggs J, Elgharably H, Biswas S, Findley M, Khanna S, Gnyawali U, Bergdall VK, Sen CK (2011) Platelet-rich fibrin matrix improves wound angiogenesis via inducing endothelial cell proliferation. Wound Repair Regen 19:753–766CrossRef
12.
Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJJ, Mouhyi J, Gogly B (2006) Platelet-rich fibrin (PRF): a second generation platelet concentrate part II: platelet related biologic features. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 101:e45–e50CrossRef
13.
He L, Lin Y, Hu X, Zhang Y, Wu H (2009) A comparative study of platelet rich fibrin (PRF) and platelet-rich plasma (PRP) on the effect of proliferation and differentiation of rat osteoblasts in vitro. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 108:707–713CrossRef
14.
Gülşen U, Şentürk MF, Mehdiyev I (2016) Flap-free treatment of an oroantral communication with platelet-rich fibrin. Br J Oral Maxillofac Surg 54:702–703CrossRef
15.
Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, Gogyl B (2006) Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part I: technological concepts and evolution. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 101:37–44CrossRef
16.
Marx RE (2003) Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 61(9):1115–1117CrossRef
17.
Wang J, Goodger NM, Pogrel MA (2003) Osteonecrosis of the jaws associated with cancer chemotherapy. J Oral Maxillofac Surg 61(9):1104–1107CrossRef
18.
Migliorati CA (2003) Bisphosphanates and oral cavity avascular bone necrosis. J Clin Oncol 21(22):4253–4254CrossRef
19.
Allen MR, Burr DB (2009) The pathogenesis of bisphosphonate-related osteonecrosis of the jaw: so many hypotheses, so few data. J Oral Maxillofac Surg 67(5 suppl):61–70CrossRef
20.
Otto S, Hafner S, Mast G, Tischer T, Volkmer E, Schieker M, Stürzenbaum SR, Tresckow EV, Kolk A, Ehrenfeld M, Pautke C (2010) Bisphosphonate-related osteonecrosis of the jaw: is pH the missing part in the pathogenesis puzzle? J Oral Maxillofac Surg 68(5):1158–1161CrossRef
21.
Sato M, Grasser W, Endo N, Akins R, Simmons H, Thompson DD, Golub E, Rodan GA (1991) Bisphosphonate action. Alendronate localization in rat bone and effects on osteoclast ultrastructure. J Clin Invest 88(6):2095–2105CrossRef
22.
Bell GW, Joshi BB, Macleod RI (2011) Maxillary sinus disease: diagnosis and treatment. Br Dent J 210(3):113–118CrossRef
23.
Costa F, Emanuelli E, Robiony M, Zerman N, Polini F, Politi M (2007) Endoscopic surgical treatment of chronic maxillary sinusitis of dental origin. J Oral Maxillofac Surg 65(2):223–228CrossRef
24.
Gupta V, Bains BK, Singh GP, Mathur A, Bains R (2011) Regenerative potential of platelet rich fibrin in dentistry: literature review. Asian J Oral Health Allied Sci 1:22–28
25.
Gassling V, Douglas T, Warnke PH, Açil Y, Wiltfang J, Becker ST (2010) Platelet-rich fibrin membranes as scaffolds for periosteal tissue engineering. Clin Oral Implants Res 21:543–549CrossRef
Metadata
Title
Management of Large Oroantral Fistulas Caused by Medication-Related Osteonecrosis with the Combined Sequestrectomy, Buccal Fat Pad Flap and Platelet-Rich Fibrin
Authors
Alparslan Esen
Sebnem Akkulah
Publication date
01-03-2021
Publisher
Springer India
Published in
Journal of Maxillofacial and Oral Surgery / Issue 1/2021
Print ISSN: 0972-8279
Electronic ISSN: 0974-942X
DOI
https://doi.org/10.1007/s12663-019-01278-x

Other articles of this Issue 1/2021

Journal of Maxillofacial and Oral Surgery 1/2021 Go to the issue

Research Paper

Maxillofacial Injuries as an Occupational Hazard of Farming in Rural and Semi-urban Population: A 3-Year Retrospective Epidemiological Study

Original Article

Emerging Trends of Zygomaticomaxillary Complex Fractures and Their Etiological Analysis in a Tertiary Health Centre from Eastern India: A Retrospective Study

Clinical Paper

Congenital Maxillomandibular Syngnathia: Review of Literature and Proposed New Classification System

Letter to the Editor

Incorrect Citation of the Arched Needle Technique for Inferior Alveolar Nerve Block

Comparative Study

Abdominal Dermis-Fat Graft Versus Conventional Temporalis Myofascial Flap Interposition in Temporomandibular Joint Ankylosis: A Prospective Clinical Comparative Study

Original Article

Correlation Between Height and Impacted Third Molars and Genetics Role in Third Molar Impaction