Copyright @ 200 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited. 7 Surgical Therapy for Osteonecrotic Lesions of the Jaws in Patients in Therapy With Bisphosphonates Gianluigi Longobardi, MD,* Roberto Boniello, DD,* Giulio Gasparini, MD,* Immacolata Pagano, HoPh, 1 Sandro Pelo, PhD* Rome, Italy Objective: Surgical therapy to improve the symp- toms and the lesions in osteonecrosis (ON) of the jaws in patients in therapy with bisphosphonates. Design: To evaluate the patient’s therapeutic pro- tocols, performance status, and factors promoting ON to prevent surgical failure. Materials and Methods: 18 patients affected by osteonecrotic lesions of the jaws associated to BF, were treated by surgery. Results: The results were recorded after 6 months. All the patients showed improvement of symp- toms, in particular the pain. In addition, all the patients referred to a sensation of fresh and clean mouth, the disappearance of fetor ex ore, and a healthy mouth. Conclusions: The management and the resolution of BF osteonecrotic lesions is arguable and complex because in most cases, the patients are affected by oncologic disease when the better approach is prevention, but when the ON lesion is clear, surgery can improve the symptoms and in some cases, it can be resolute. To prevent surgical failure, it can be useful to evaluate the patient’s therapeutic protocols, performance status, and factors promot- ing ON. Key Words: Bisphosphonates, osteonecrosis, therapy, jaw L iterature of recent years has reported many cases of osteonecrotic (ON) lesions of the jaws in oncologic patients under biphospho- nate (BF) therapy. 1Y8 Nevertheless, the phy- siopathology of osteonecrosis is not yet clear because the direct cause-effect action between ON and BF. The unquestioned utility of BF in the manage- ment of bone pathology and their presence in therapeutic protocols 5,9,10 of patients affected with skeletal metastasis remain, in contrast with event complication (i.e. ON), because international litera- ture is in agreement in saying that this kind of lesion does not replay at any surgical or pharmacological treatment. 1,5,6 Actually, the main and the acknowledged management of this kind of lesion is the preventive measures taken during oral care before the start of any BF therapy. In the following study, data of 18 patients treated with surgery are reported because these patients were affected by osteonecrotic lesions asso- ciated with BF. MATERIALS AND METHODS A t the operative unit of Maxillo Facial Surgery at the Universita ` Cattolica del Sacro Cuore, Rome, Italy, in 2005, 18 patients affected by osteonecrosis of the jaws were treated with surgery. From the anamnesis, it was clear that all patients were in therapy with BF (oral assumption or endovenous subministration) because some of them were dis- tressed by skeletal metastasis for neoplasia, others for serious osteoporosis. Table 1 shows the data related to the treated patients. The average age was 55 with a female/male ratio of 13/5. Oncology was the basic pathology (BP) for 15 of them, whereas for the others, it was osteoporosis. All patients (Pz) were treated with BF; in particular, 11 of them with zoledronic acid (endovenous subministration), three others with pamidronic acid (endovenous subministration), two others with cloridronic acid, and the last two with neridronic acid (oral administration). Table 1 1012 From the *Department of Maxillo Facial Surgery, Catholic University of ‘‘Sacro Cuore;’’ and the 1 Italian Agency of Drugs, Rome, Italy. Address correspondence and reprint requests to Gianluigi Longobardi, MD, Catholic University Medical School, via P. Maffi 102, 00168, Rome Italy; E-mail: gianluigilongobardi@ libero.it