Outcomes of sequestrectomy and buccal fat pad reconstruction in the management of medication-related osteonecrosis of the jaws

Jose, Anson; Rawat, Aditi; Nagori, Shakil Ahmed; Arya, Saurav; Shukla, Deepak

doi:10.1007/s10006-021-00973-9

Cited by 9 publications

(20 citation statements)

References 17 publications

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“…The need to achieve mucosal integrity rapidly can not only be a reason for early operations but also signifies that when primary closure is possible, surgical procedures can take place [ 24 ]. In the case of maxilla surgeries, the buccal fat graft can be used to acquire primary healing [ 25 , 26 ]. Second, when mucosal integrity can be achieved.…”

Section: Discussionmentioning

confidence: 99%

Associated systemic diseases and etiologies of medication-related osteonecrosis of the jaw: a retrospective study of 265 surgical cases

Chang

Kim

Ahn

2023

Maxillofac Plast Reconstr Surg

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Background Medication-related osteonecrosis of the jaw (MRONJ) is one of the complications caused by various drugs. As there are increasing reports of MRONJ, it is important to diagnose and identify patients who have the potential risk of the disease. The aim of this study was to analyze the systemic diseases, etiology, and treatment results of MRONJ. Material and methods A total of 265 MRONJ operations were reviewed retrospectively. This study included patients who were diagnosed as MRONJ and those who also received surgery, ranging from simple extraction to reconstruction with free flaps, from 2009 to 2021. Each patient’s systemic disease and eitology and basic demographic information was taken into consideration. Results The most common diseases related were osteoporosis (n = 127), breast cancer (n = 77), multiple myeloma (n = 27), prostate cancer (n = 26), and etc. (n = 12). The related causes of MRONJ were extraction (n = 138), implants (n = 40), and irritations by prosthesis (n = 29); however, 55 cases were occurred spontaneously. Out of 265 patients, 214 were women while 51 were men. The average age when the surgery took place was 67.7 and 69.8 years for male and female patients, respectively. Saucerization and sequestrectomy (n = 252) was the most common surgical treatment, followed by mandibulectomy (n = 12) and partial maxillectomy (n = 1). While 4 cases occurred in both jaws, 168 cases were in the mandible and 93 cases were in the maxilla. Conclusion Nearly 50 % of the MRONJ patients had osteoporosis and the other patients who received bone targeting agents parentral had bone metastasis of various cancers. Extraction is the most common related event for MRONJ.

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Section: Discussionmentioning

confidence: 99%

Associated systemic diseases and etiologies of medication-related osteonecrosis of the jaw: a retrospective study of 265 surgical cases

Chang

Kim

Ahn

2023

Maxillofac Plast Reconstr Surg

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“…However, a limited number of studies have proposed free flaps for MRONJ lesions, mainly mandibular lesions, with poor vascularization and large soft tissue defects (Jose et al, 2022;Lemound et al, 2018). Furthermore, Sacco et al (2021) stated that free transfer of vascularized bone tissue and/or free osteo-fasciocutaneous flap as treatment for patients in stages 2 and 3 of MRONJ may increase sequelae and complications.…”

Section: Discussionmentioning

confidence: 99%

“…With regard to en bloc resection, the overall improvement rate reported by Hallmer et al (2018) was 92.5%. Soft tissue flaps are made to promote complete coverage of exposed bone after removal of necrotic bone, and coverage is imperative to prevent recurrence and progression of the disease (Jose et al, 2022). The flaps that can be employed are described in Table 3.…”

Section: )mentioning

confidence: 99%

Surgical treatments for medication-related osteonecrosis of the jaws: advantages and limitations

Silva

Santiago

Campos

et al. 2023

RSD

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Objective: The purpose of this paper is to discuss the surgical methods available for the treatment of MRONJ, pointing out their advantages and limitations. Methodology: An integrative review of the literature was performed by searching the PubMed virtual database using the MeSH term "bisphosphonate associated osteonecrosis of the jaw/surgery" and including 26 publications. Results: Surgical intervention is presented as a treatment option in an attempt to reduce disease progression with the recognition that this early intervention may predict beneficial outcomes for the patient. Surgical approaches confer superior treatment outcomes over conservative treatments, with success rates of 80-90% and 10-62%, respectively. To establish treatment, consideration should be given to therapy for removing nonhealing exposed bone, which can be accomplished through curettage, sequestrectomy, and surgical resection. When approaching soft tissue, different flaps can be performed, according to their indications. Conclusion: Surgical treatment has shown maintenance of mucosal coverage, improved quality of life, and quick resumption of antiresorptive therapy for all stages of the disease, with high rates of therapeutic success. However, continued efforts should be encouraged to investigate the best treatment for this pathology.

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“…It is widely accepted that wounds need to be closed during MRONJ surgery. In our previous study of tooth extraction in patients treated with antiresorptive agents, open wounds became one of the risk factors for developing MRONJ [ 35 ]. Resection of the maxillary sinus mucosa by ESS opens the maxillary bone surface into the maxillary sinus, which may cause local infection by maxillary sinus bacteria and worsen MRONJ lesions.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of Treatment Outcomes of Maxillary Sinusitis Associated with Medication-Related Osteonecrosis of the Jaw

Otsuru

Hayashida

Morishita

et al. 2022

IJERPH

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Although maxillary sinusitis often occurs in patients with medication-related osteonecrosis of the jaw (MRONJ) of the upper jaw, there have been few reports on the treatment and outcomes for maxillary sinusitis associated with maxillary MRONJ. This study aimed to retrospectively investigate the treatment outcomes of maxillary sinusitis in patients with MRONJ of the upper jaw. There were 34 patients diagnosed with maxillary MRONJ and sinusitis by preoperative computed tomography who underwent surgery in our institution between January 2011 and December 2019. Age, sex, primary disease, stage of MRONJ, class and administration period of an antiresorptive agent, corticosteroid administration, preoperative leukocyte count and serum albumin level, periosteal reaction, sinusitis grade, maxillary sinus surgical procedure, and treatment outcomes of MRONJ and sinusitis were examined. There were 7 male and 27 female patients (average age, 74.7 years). Complete healing of MRONJ was obtained in 29 of 34 patients (85.3%). Maxillary sinusitis resolved or improved in 21 patients (61.8%) but did not change or worsen in 13 patients (38.2%). We found that complete resection of necrotic bone with intraoperative irrigation of the maxillary sinus may provide good treatment outcomes for maxillary sinusitis associated with MRONJ, although our findings were not statistically significant owing to the small number of patients.

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Outcomes of sequestrectomy and buccal fat pad reconstruction in the management of medication-related osteonecrosis of the jaws

Cited by 9 publications

References 17 publications

Associated systemic diseases and etiologies of medication-related osteonecrosis of the jaw: a retrospective study of 265 surgical cases

Associated systemic diseases and etiologies of medication-related osteonecrosis of the jaw: a retrospective study of 265 surgical cases

Surgical treatments for medication-related osteonecrosis of the jaws: advantages and limitations

Retrospective Analysis of Treatment Outcomes of Maxillary Sinusitis Associated with Medication-Related Osteonecrosis of the Jaw

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