The Utilization of the Buccal Fat Pad Graft for a Predictable Resolution of Oral-Antral Fistulae in Patients With BRONJ of the Maxilla
James C. Melville, DDS *
Ramzey Tursan, DDS**
Robert E. Marx, DDS ***
- Abstract: Nitrogen containing bisphosphonates are frequently used to treat postmenopausal and corticosteroid induced osteoporosis. They are also used in the treatment of Multiple Myeloma, bony metastases and hypercalcemia of malignancy. However osteonecrosis of the jaw has been reported following both intravenous and oral use. More than 12 million Americans and another 10 million are thought to be taking a bisphosphonate worldwide. Increasingly exposed bone with oral-antral fistulae has been known to occur as a specific presentations of bisphosphonate-related osteonecrosis of the jaw. Oral-antral communications caused by Bisphosphonate concomitant with a secondary sinusitis represents a unique treatment challenge for the oral and maxillofacial surgeon.
- MATERIAL AND METHODS: The aim of this retrospective study is to share our experience with the Buccal fat pad combined with radical sinusotomy for the treatment of oral antral fistulae (OAF) with sinusitis in the ONJ maxilla. The present study reviewed patients treated at the University of Miami Oral and Maxillofacial Surgery Department, during a five-year period between 2008 and 2013. We identified 18 patients, (2 men, 16 women) Mean average age (66yo). All patents were taking oral or intravenous nitrogen containing bisphosphonates before the development of OAF of the maxillary sinus. All patients complained of persistent pain, swelling, and purulent drainage. All cases were treated with an appropriate drug holiday followed by debridement of the necrotic bone and teeth as well as a radical sinusotomy to eliminate chronic infection and polyps in the maxillary sinus. A buccal pad freed from its infratemporal location with a pericapsular dissection and advanced into the defect together with a primary mucosal closure was used to close the fistula.
- RESULTS: We report a 100% success rate related to complete resolution of the OAF associated with bisphosphonate exposure. However, 2 patients developed more bone exposure after a return to bisphosphonate use in an adjacent area of the maxilla. In one other patient OAF reoccurred due to a failed bone grafting attempt.
- CONCLUSIONS: The buccal fat pad can be used as an effective and predictable technique for the resolution of Oral-antral fistulas due to bisphosphonate induced osteonecrosis. However it does not prevent the patient from developing more exposed bone in the future due to either further bisphosphonate therapy or the 11 year half life of these drugs.
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