Evaluation of Surgical Treatment for Medication- Related Osteonecrosis of the Jaw

Abstract

Abstract Objective To investigate the efficacy of surgical treatment for medication-related osteonecrosis of the jaw (MRONJ). Methods Twenty-eight patients with MRONJ who underwent surgical operation in the Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Wenzhou Medical University from November 2016 to August 2021 were enrolled, and a retrospective analysis of clinical data (gender, age at onset, cause of onset, disease stage, treatment and prognosis, etc.）was performed. In 20 patients with stage 2 lesions, partial jaw resection was performed, and the soft tissues were tightly sutured under tension-free conditions, including direct sutures and indirect sutures using adjacent flaps with or without absorbable collagen membrane. In 8 cases of stage 3 lesions, sequestrum was performed and a drainage channel was formed. Regular follow-up was performed after operation, and the surgical efficacy was evaluated according to the clinical manifestations, pain scores, and X-ray examinations of the patients. Results There were 13 male and 15 female MRONJ patients respectively, and the age at onset was (69.18±7.42) years old. According to the guidelines of the American Association of Oral and Maxillofacial Surgery (AAOMS), the patients were divided into stage 2 and 3. As for the stage 2 MRONJ patients, who were followed up for 10-53 months after operation, the rate of unplanned reoperation was 10% (1/20), and the pain score at the 3rd month after operation was [(0.35±0.49) points], which was significantly lower than the preoperative pain score [(3.40±0.82) points] (P<0.05). The unplanned reoperation rate of MRONJ patients in stage 3 was 0% during the follow-up of 19-84 months, and the pain score at the 3rd month after operation was [(0.63±0.52) points], significantly lower than the preoperative one [(5.37±1.06) points] (P<0.05). Conclusions Surgical treatment is necessary to cure MRONJ for patients who has failed non-surgical treatment. For patients with stage 2 MRONJ, complete removal of necrotic bone and tension-free closure of mucosal wounds are the keys to successful surgery. For stage 3 MRONJ patients, the goal is to remove sequestrum, establish drainage, relieve pain, and prevent worse progression of the disease.