O-2614 EXTRA-PLATYSMATIC FIXATION OF BISPHOSPHONATE–RELATED MANDIBULAR FRACTURES: A SUGGESTED TECHNICAL SOLUTION

Bisphosphonate-related osteonecrosis of the jaws (BRONJ ) is an evolving epidemic the maxillofacial surgeon is dealing with. The causes of this disease are not fully understood; the most widely accepted etiopathological hypothesis is that in certain individuals bisphosphonates increase trabecular bone density to the point of inducing vascular insuffi- ciency with a consequent bone necrosis. The current focus is on prevention and only conservative symptomatic treatment are advised. When BRONJ occurs most surgeons agree with the simple removal of the necrotic bone. Unfortunately sometimes conservative treatments aren’t successful, and the disease inexorably evolves to a clinical situation with the need of a more complex management. The necrosis can evolve and produce an extraoral fistula and osteolysis extending to the inferior border and some- times a mandibular fracture may occur. In the literature there are few reports of the treatment of pathological mandibular fracture caused by BRONJ . This clinical situation usually occurs in oncologic patients in poor general conditions and the aim of the surgical treatment in generally limited to pain control, and allow- ance of feeding. The local situation of BRONJ related fractures may pre- vent traditional open surgery with direct position of stabi- lization by plates because of the high risk of a further reduction of vascular flow to the bone stumps. Moreover the rigid fixation is likely to fail because of plate and screw infection due to the infection usually present into the surgical field. Under these conditions healing of the fracture is impaired and maintenance of infection almost guaranteed. We present an useful surgical technique for the stabiliza- tion of BRONJ related mandibular fractures applying an extra-platysmatic reconstructive plate. With this technique the healing of bone fracture is not achieved but the plates fixed with this technique are stable and may not get infected, while patients are pain free and can eat easily , with a great improvement of their quality of life.