A technique for the treatment of oral–antral fistulas resulting from medication-related osteonecrosis of the maxilla: the combined buccal fat pad flap and radical sinusotomy

Objective Bisphosphonates and monoclonal antibodies directed at osteoclastic function are frequently used to treat postmenopausal and corticosteroid-induced osteoporosis. They are also used in the treatment of certain metastatic malignancies. However, osteonecrosis of the jaw has been reported after intravenous, subcutaneous, or oral use of these agents. More than 12 million Americans and another 20 million worldwide are thought to be taking a bisphosphonate. Exposed bone with oral–antral fistulas has been known to occur increasingly as a specific presentation of what is now termed medication-related osteonecrosis of the jaws (MRONJ) with a specific International Classification of Diseases, 10th revision (ICD-10) code. Oral–antral communications caused by bisphosphonate concomitant with secondary sinusitis represent a unique treatment challenge for the oral and maxillofacial surgeon. The purpose of this article is to demonstrate a simple but effective technique to treat oral–antral communications caused by MRONJ. Study Design With the review and approval of the University of Miami Internal Review Board, we identified 23 patients who had undergone this surgical procedure. Results We report a 100% resolution of osteonecrosis of the jaw (ONJ) and sinusitis with repneumatization. Conclusions The buccal fat pad and radical sinustomy can be used as an effective and predictable technique for the resolution of oral–antral fistulas caused by MRONJ.