Deepak Kademani, DMD, MD, Sreenivas Koka, DDS, MS, PhD, Martha Q

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Primary Surgical Therapy for Osteonecrosis of the Jaw Secondary to Bisphosphonate Therapy Deepak Kademani, DMD, MD, Sreenivas Koka, DDS, MS, PhD, Martha Q. Lacy, MD, S. Vincent Rajkumar, MD Mayo Clinic Proceedings Volume 81, Issue 8, Pages 1100-1103 (August 2006) DOI: 10.4065/81.8.1100 Copyright © 2006 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 1 Case 1. Area of ulcerated bone exposure with overlying granulation tissue in the right posterior mandible secondary to bisphosphonate therapy and an uncomplicated dental extraction 6 months previously. Mayo Clinic Proceedings 2006 81, 1100-1103DOI: (10.4065/81.8.1100) Copyright © 2006 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 2 Case 1. Limited surgical exposure delineating the area of bone sequestration and poorly healed dental extraction site. This area was meticulously débrided to limit surgical trauma. Mayo Clinic Proceedings 2006 81, 1100-1103DOI: (10.4065/81.8.1100) Copyright © 2006 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 3 Case 1. After sufficient subperiosteal-releasing incisions were made to facilitate closure, the soft tissue overlying the bony defect was closed in a tension-free fashion. Complete soft tissue healing ensued without incident. Mayo Clinic Proceedings 2006 81, 1100-1103DOI: (10.4065/81.8.1100) Copyright © 2006 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 4 Case 1. Site of osteonecrosis of the jaw 4 months after primary surgical management. Mayo Clinic Proceedings 2006 81, 1100-1103DOI: (10.4065/81.8.1100) Copyright © 2006 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 5 Area of established osteonecrosis in the left retromolar trigone of the mandible with a large area of mucosal dehiscence. This patient was treated with local débridement and closure with a buccal fat pad rotational flap that was allowed to mucosalize in the oral cavity. Mayo Clinic Proceedings 2006 81, 1100-1103DOI: (10.4065/81.8.1100) Copyright © 2006 Mayo Foundation for Medical Education and Research Terms and Conditions