SUMMARY
Osteonecrosis of the jaw is a group of three types of diseases: osteoradionecrosis, medication-related osteonecrosis of the jaw and avascular osteonecrosis of the jaw, with different etiology and morphology, that have in common presence of necrosis in a part or in the whole jaw.
Clinical manifestation of osteonecrosis of the jaw can have various courses, from asymptomatic to complicated forms with extensive jaw inflammatory processes, deep neck infections or sepsis. Incidence of osteonecrosis is currently growing mostly due to the enlarging group of drugs which can cause antiresorptive agent-related osteonecrosis of the jaw as undesirable side effects. The number of osteoradionecrosis is likewise not diminishing despite the technical advances in radiotherapy, while simultaneously the number of patients with cancer in head and neck region is rising. The treatment of the osteonecrosis of the jaw both pharmacological and surgical is still challenging and not always allowing to avoid critical complications such as pathologic fractures, recurrent infections of the jaw or insufferable pain resistant to treatment. Radical surgical resection of necrotic tissue with immediate reconstruction of defect is the treatment of choice for the terminal stages of osteonecrosis, when conservative and basic surgical treatment fails to bring satisfactory results.
Reconstruction of lost soft tissues and bone of the jaws depends on the size and character of the defect, patient´s general health condition and comorbidities and the surgical skills of the unit.
Resection of large necrotic lesion and pathologic fracture of jaw generates extensive surgical defect, which may require microvascular free bone flap reconstruction with autotransplantation of vascularized osseous tissue. Removal of the necrotic bone and reconstruction with autotransplanted microvascular free flap enables to renew the continuity of bone and to restore the function of the jaw with own bone and provides patient the chance to heal with adequate esthetic and functional result.
Keywords: osteonecrosis, osteoradionecrosis, radiotherapy, antiresorptive agent-related osteonecrosis of the jaw, ARONJ, microvascular flap, free fibular flap.
Lek Obz, 2020, 69 (12): 473-482
Adam STEBEL 1,2, Barbora HOCKOVÁ 1, Dorota ŠTORCELOVÁ 1, Juraj ABELOVSKÝ 1, Rastislav SLÁVIK 1,2, Peter STANKO 2
1 Oddelenie maxilofaciálnej chirurgie, Fakultná nemocnica s poliklinikou F. D. Roosevelta, Banská Bystrica, primár MUDr. R. Slávik
2 Klinika stomatológie a maxilofaciálnej chirurgie LF UK a OÚSA, Bratislava, prednosta prof. MUDr. P. Stanko, PhD.
CITE:
STEBEL A., HOCKOVÁ B., ŠTORCELOVÁ D., ABELOVSKÝ J., SLÁVIK R., STANKO P.: Osteonecrosis Of the Jaw – Treatment Of Terminal Stage Disease With Microvascular Free Fibula Flap.Lek Obz, 2020, 69 (12): 473-482
