Journal of Oral and Maxillofacial Surgery
Volume 67, Issue 3 , Pages 589-592, March 2009

The Role of Inferior Alveolar Nerve Involvement in Bisphosphonate-Related Osteonecrosis of the Jaw

  • Sven Otto, DDS

      Affiliations

    • Resident, Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University, Munich, Germany
    • Corresponding Author InformationAddress correspondence and reprint requests to Dr Otto: Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University, Lindwurmstrasse 2a, München, 80337 Germany
    • ,
  • Sigurd Hafner, DDS

      Affiliations

    • Resident, Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University, Munich, Germany
    • ,
  • Knut A. Grötz, MD, DDS, PhD

      Affiliations

    • Professor and Head, Department of Oral and Maxillofacial Surgery, Horst-Schmidt-Klinikum, Wiesbaden, Germany

Purpose

Hypesthesia or anesthesia of the lower lip (Vincent's symptom) is a common sign in patients with osteomyelitis of the mandible, especially in severe cases.

Patients and Methods

We observed an involvement of the inferior alveolar nerve in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ). Surprisingly, we found Vincent's symptom also in patients with limited and early stages of BRONJ.

Results

These patients were successfully treated by surgical removal of the necrotic bone combined with preoperative and postoperative administration of antibiotics. We report on the occurrence and management of an involvement of the inferior alveolar nerve in patients with BRONJ and discuss possible causes.

Conclusion

We conclude that impairment of inferior alveolar nerve function can be an important early symptom or even the presenting symptom of BRONJ that is also easily detectable by bisphosphonate-prescribing physicians. Concerning the management of BRONJ, we conclude that surgical removal of necrotic bone combined with antibiotics is an adequate treatment in patients with osteonecrosis of the jaw.

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PII: S0278-2391(08)01508-5

doi:10.1016/j.joms.2008.09.028

Journal of Oral and Maxillofacial Surgery
Volume 67, Issue 3 , Pages 589-592, March 2009

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