Surgical treatment of medication‐related osteonecrosis of the upper jaw: Case series

Abstract

Purpose The management of maxillary medication‐related osteonecrosis of the jaw (MRONJ) is challenging. Therefore, identifying the proper treatment is important. This study aimed to evaluate the surgical treatment of maxillary MRONJ using single‐layer closure with mucoperiosteal flap and double‐layer closure with buccal fat pad flap (BFPF) and mucoperiosteal flap and to find the outcomes after rehabilitation with obturators. Methods A retrospective analysis was conducted and included all surgically treated and followed‐up maxillary MRONJ cases in a single center. Demographics and clinical data, stage of MRONJ, surgical treatment, and treatment outcome were collected. Results Seventy‐nine lesions were included. Removal of necrotic bone was followed by coverage with mucoperiosteal flap in 60 lesions and BFPF in 14 lesions. Seven lesions (five primarily and two following unsuccessful treatment with BFPF) underwent necrectomy and were reconstructed with obturators. Complete mucosal healing was achieved in 76.7% of the lesions covered with mucoperiosteal flap. BFPF led to complete mucosal healing in 85.7% of the lesions. No complications were observed in the defects rehabilitated with obturators. Conclusion Removal of necrotic bone followed by closure with mucoperiosteal flap is reliable for MRONJ treatment. BFPF is effective for closure of MRONJ‐related oroantral communications (OACs).

Workshop of European task force on medication‐related osteonecrosis of the jaw—Current challenges

“…However, there is an increasing body of evidence suggesting that surgical removal of necrotic bone might be curative in patients with all MRONJ stages (Aljohani et al, 2019;Otto et al, 2018;Ristow et al, 2018), where cure is defined as long-term resolution of symptoms and complete mucosal closure (absence of residual bone exposure). Other studies have documented high success rate of surgical treatment compared to non-surgical treatment (Aljohani et al, 2019;Hauer et al, 2019;Yamada et al, 2018).…”

Medication-related osteonecrosis of the jaw : occurence, risk factors, pathogenesis & treatment

“…In 10 patients, treated with sequestrectomy (local resection) healing occurred in 5 (50%) and in 40 patients treated with block resection, 31 patients healed (77.5%). Our success rate for patients treated with block surgery is in accordance with other studies (Aljohani et al, 2018;. The results are further strengthened by Favia et al who in a recent publication concluded that MRONJ occurring both in neoplastic and non-neoplastic patients benefits more from a surgical treatment approach, whenever deemed possible, as non-surgical treatments do not seem to allow complete healing of the lesions (Favia et al, 2018).…”

“…When obtaining success rates in surgical treatment of MRONJ lesions in both cancer patients and osteoporotic patients as high as those in study III and similar studies (Aljohani et al, 2018;, much depends on the surgeon's skill and expertise (Ristow et al, 2015). A major challenge of surgical treatment is to distinguish the demarcation between viable and necrotic bone so that a minimum amount of bone is removed.…”

Medication-Related Osteonecrosis of the Jaw with Spontaneous Hemimaxilla Exfoliation: Report of a Case in Metastatic Renal Cancer Patient under Multidrug Therapy

“…In many cases, surgical treatment of stage III MRONJ patients leads to oroantral communication in the posterior maxilla. The closure of these defects represents an additional challenge to the oral surgeon and is essential to improve the long‐term life quality [ 13 ].…”