Intérôt de l’oxygénothérapie hyperbare dans la prévention et le traitement des ostéonécroses des maxillaires dues aux bisphosphonates

Abstract

Interest of hyperbaric oxygen therapy in the prevention and treatment of bisphosphonate-related osteonecrosis of the jaws. Bisphosphonates (BP) have been used since 1960s for their capability to alter the mechanism of bone resorption and remodeling. Intravenous (IV) BP are effective in the treatment and management of cancer-related conditions including hypercalcemia of malignancy, skeletal-related events associated with bone metastases in the context of solid tumors such as breast cancer, prostate cancer and lung cancer, and management of lytic lesions in the setting of multiple myeloma. Oral BP are used to treat osteoporosis and osteopenia. In 2003, oral and maxillofacial surgeons first recognized and reported cases of non-healing exposed bone in the maxillofacial region in patients treated with IV bisphosphonates. This adverse effect was called BONJ for bisphosphonate-related osteonecrosis of the jaws. Clinically, BONJ is defined by an exposed bone in the maxillofacial region that has persisted for more than 8 weeks. So far, the etiopathogenesis of BONJ remains uncertain. It is worth noting that BP act at the following levels: physicalchemical, tissue, cellular, and molecular. In 2007, then in 2009, strategies for management of patients with or at risk for BONJ were set forth in the American Association of Oral and Maxillofacial Surgeons (AAOMS) Position Paper on BONJ. BONJ's treatment comprises the following: pain control, antibiotic therapy, mouth rinse, BP discontinuation, and surgical debridement. Such measures, however, do not always achieve the resolution of the clinical findings. That led numerous authors to suggest, in complement to treatments advised by AAOMS, many experimental treatments as hyperbaric oxygen therapy (HBOT). HBOT is a way of treatment which increases the oxygen content of the blood and, consequently, the amount of oxygen delivered to tissues. The proposed rationale behind the beneficial effects of HBOT in ONM is increased wound healing, reduction of oedema and inflammation, stem cell mobilization and moderation of the suppression of bone turnover by BP. At the moment there is a controversy concerning the effectiveness of HBOT in the treatment of BONJ. But there are two ongoing randomized controlled trials in USA which are testing specifically the effectiveness of adjunctive HBOT in the management of BONJ. Although early results are encouraging, evidence-based conclusions could be made after the final results of these studies are published. © SFCO, 2013.