Ask An Expert: Osteonecrosis of the Jaw

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Ask An Expert: Osteonecrosis of the Jaw

Question:

I was recently diagnosed with osteonecrosis of the jaw. What do you do to treat this disease? Is there any hope at all for facial reconstruction?

Answer:

Osteonecrosis of the jaw can occur as a rare side effect of drugs called bisphosphonates. These medications are used to treat osteoporosis and certain cancers that invade the bones. The ones that are given by intravenous infusion (IV) appear to have a 1% risk of osteonecrosis. The risk is lower in people who take bisphosphonate drugs by mouth for osteoporosis.

In the past, osteonecrosis of the jaw was seen primarily in patients who had received radiation of the jaw (called osteoradionecrosis of the jaw). In osteoradionecrosis, the radiation damages the blood supply to the bone and the bone dies. This becomes a problem when the bone is exposed — not covered by any tissue or skin. It also is a problem when surgery is considered because nothing will heal the dead bone.

In the past the only effective treatment was to remove the dead bone in order to uncover healthy living bone.  The problem with that solution is that there is usually a marginal area where the bone's blood supply is barely adequate to keep the bone alive but is not adequate to heal up any injuries or help heal a bone graft.  The amount of bone removed then had to be extensive — usually to the edge of the radiated bone, and even then healing was not guaranteed.

More recently two improvements have occurred.  First, tissue that brings its own blood supply can now be transferred into almost any area of the body.  This tissue does not rely on getting blood from surrounding tissues to heal.

Second, treatment with hyperbaric oxygen can increase the oxygen to the tissues while they are healing.  This is done by putting the patient in a hyperbaric oxygen chamber daily for up to six weeks until the surgery site has healed. Both of these techniques are available at most major teaching hospitals in major cities now, so reconstruction can usually be done for most problems.

The problem of osteonecrosis related to bisphosphonate drugs is so recent that the best therapy is still under investigation.

David Vernick, M.D. is assistant clinical professor of otology and laryngology at Harvard Medical School and interim chief of the Division of Otology and Laryngology at Beth Israel Deaconess Medical Center.

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Last updated:	January 24, 2007