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

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 osteonccrosis 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 hone 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 bean 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 in adequate treatment in patients with osteonecrosis of the jaw. (C) 2009 American Association of Oral and Maxillofacial Surgeons