The Role of Mylohyoid Flap in the Treatment of Bisphosphonate Related Osteonecrosis of the Jaws

Publication date: Available online 8 January 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Thomas Mücke, Steffen Koerdt, Maximilian Jung, David A. Mitchell, Klaus-Dietrich Wolff, Marco Rainer Kesting, Denys John Loeffelbein
IntroductionSurgical treatment of Bisphosphonate Related Osteonecrosis of the Jaws (BRONJ) combines excision of adequate damaged bone and watertight coverage by appropriate vascularised tissue. Local tissues are preferred when possible. This study compares local mucoperiosteal flaps with mylohyoid flaps with special emphasis on their influence on wound healing.Material and MethodsA total of 195 patients with BRONJ in the mandible were included in this prospective study. The control group (n=169) were treated with a mucoperiosteal flap, whereas patients of the study group (n=26) received a mylohyoid flap.ResultsRecurrence of BRONJ was significantly reduced (p=0.023) as was extent of necrosis (p=0.001) in patients with mylohyoid flaps.DiscussionThis study demonstrates the importance of a sufficient mucosal coverage in surgical treatment of BRONJ. The mylohyoid flap provides an additional tissue coverage, which seems to account for the significantly reduced rate of disease recurrence.ConclusionThe vascularized mylohyoid flap is an important tool in the complex and challenging surgical care of BRONJ.



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