Non-complex reconstructive techniques in the management of BRONJ: a case series of patient-related outcomes

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-recognised condition that continues to be a therapeutic challenge. It can have devastating effects on patients' quality of life. The literature recommends a myriad of management strategies. This case series demonstrates a combination of resection procedures, local reconstruction options and their impact on quality of life.

This case series consisted of three patients with BRONJ following the use of bisphosphonates (BPs); for metastatic and metabolic bone diseases, none responded to conservative treatment. All patients were surgically managed by a standardised protocol combining bone resection and local reconstructive measures.

We evaluated surgery-related change in quality of life using the "University of Washington Quality of Life Questionnaire". At 3 months, all patients were pain free but were only able to manage soft foods and one persisted in using a straw for fluids. In all cases, quality of life scores showed an overall improvement or remained unchanged. There was no evidence of BRONJ recurrence.

Quality of life is an important consideration in the management of BRONJ patients. Optimal surgical resection and reconstruction may be an ideal treatment plan, but in medically compromised patients, this may not be possible. Consideration should be given to modified strategies with a potentially lower morbidity, yet still aiming to improve patients' quality of life.