Universität zu Köln

Zirk, Matthias, Kreppel, Matthias, Buller, Johannes, Pristup, Julij, Peters, Franziska, Dreiseidler, Timo, Zinser, Max and Zoeller, Joachim E. (2017). The impact of surgical intervention and antibiotics on MRONJ stage II and III - Retrospective study. J. Cranio-MaxilloFac. Surg., 45 (8). S. 1183 - 1190. EDINBURGH: CHURCHILL LIVINGSTONE. ISSN 1878-4119

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Abstract

Objectives: Metastatic bone disease and osteoporosis are the main indications for bisphosphonates and anti-resorptive agent therapy. Inhibition of bone turnover and angiogenesis are mainly responsible for the development of Medication Related Osteonecrosis of Jaws (MRONJ) as therapeutic side-effect. Yet, the role of infection for the development and recurrence of MRONJ is not fully elucidated. The aim of this retrospective study is to explore if a difference in antibiotic regimes has an impact on the surgical intervention needed to achieve a painless stable stage of the disease. Furthermore, we investigated concomitant submucosal infections in local relation to the MRONJ site. Methods: A retrospective study (2006-2015) of 143 patients treated with MRONJ stage II and stage III in a single institutional university hospital was performed. All patients experienced at least one surgical intervention and received antibiotics. Their medical records, pathological and microbial findings were reviewed. Data was controlled for the achievement of an event free time period of at least 12 months. Results: We investigated the number and kind of treatments that were performed on patients with MRONJ stage II and III to achieve a painless stable stage of the disease. The first and second healing approach differed significantly from each other (p < 0.05). In 7 (4.9%) cases up to four surgical interventions were needed to achieve oral rehabilitation. In 135 (95.1%) of all cases a segmental resection could be prevented, with extended decortication being the most applied method. Patients under peri-operative ampicillin/sulbactam showed a significant reduction for a second or fourth intervention compared to the clindamycin group (p < 0.05). Results for a third intervention presented a similar difference between both groups, but were not significant (p = 0.06). Intraoperatively in 76 out of 241 (31.5%) cases presented putrid submucosal infections. The isolated bacteria were gram-negative facultative anaerobes (39.1%) and strictly anaerobic bacteria (gram-positive/38.2%, gram-negative/19.1%). Susceptibly of the cultured bacteria were significantly (p < 0.05) in favor to ampicillin/sulbactam (79.1%) compared to clindamycin (49.5%). Conclusion: The perioperative antibiotic regime for patients with MRONJ stage II and III undergoing surgically treatment does have an influence on the recurrence of the disease. Further investigation is needed to elucidate the role of infection in the treatment of MRONJ. (C) 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Zirk, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Kreppel, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Buller, Johannes UNSPECIFIED UNSPECIFIED UNSPECIFIED Pristup, Julij UNSPECIFIED UNSPECIFIED UNSPECIFIED Peters, Franziska UNSPECIFIED UNSPECIFIED UNSPECIFIED Dreiseidler, Timo UNSPECIFIED UNSPECIFIED UNSPECIFIED Zinser, Max UNSPECIFIED UNSPECIFIED UNSPECIFIED Zoeller, Joachim E. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-223211
DOI:	10.1016/j.jcms.2017.05.027
Journal or Publication Title:	J. Cranio-MaxilloFac. Surg.
Volume:	45
Number:	8
Page Range:	S. 1183 - 1190
Date:	2017
Publisher:	CHURCHILL LIVINGSTONE
Place of Publication:	EDINBURGH
ISSN:	1878-4119
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language BISPHOSPHONATE-RELATED OSTEONECROSIS; MEDICATION-RELATED OSTEONECROSIS; NECK SPACE INFECTIONS; RISK-FACTORS; CANCER-PATIENTS; JAW BRONJ; THERAPY; MANAGEMENT; OUTCOMES; MICROBIOLOGY Multiple languages Dentistry, Oral Surgery & Medicine; Surgery Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/22321