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. 2020 Jun 29;10(7):99.
doi: 10.3390/life10070099.

Oral Surgical Management of Bone and Soft Tissues in MRONJ Treatment: A Decisional Tree

Antonia Marcianò  1 , Erasmo Rubino  2 , Matteo Peditto  2 , Rodolfo Mauceri  3 , Giacomo Oteri  2
Affiliations

Oral Surgical Management of Bone and Soft Tissues in MRONJ Treatment: A Decisional Tree

Antonia Marcianò et al. Life (Basel). .

Abstract

Background: The aim of the present work was to analyze a 10-year retrospective series of surgically treated medication-related osteonecrosis of the jaws (MRONJ) cases, reporting the clinical outcome and success rate for each adopted procedure in order to draw a treatment algorithm that is able to standardize clinical decision making and maximize the success of oral surgical treatment of MRONJ.

Methods: Different surgical approaches were categorized taking into consideration two variables a) hard tissue management (defined as debridement, saucerization or marginal resective surgery of maxillary necrotic bone) and b) soft tissue management (defined as type of flap design and related modality of wound-healing).

Results: For the retrospective cohort study, 103 MRONJ patients were enrolled and a total of 128 surgical procedures were performed. The role of radical-intended surgery using local flaps in MRONJ treatment was investigated, as well as palliative treatments. All stage I-II patients completely healed when a combination of radical necrotic bone surgery associated with a first intention healing of soft tissues was obtained. In stage III, when a patient was not eligible for maxillo-facial surgery, the use of palliative surgical strategies was effective in symptom relief in order to maintain a better quality of life for the duration of the patient's life.

Conclusions: Oral surgery with radical intent associated with a flap design able to ensure first intention healing might represent a valid option for the majority of MRONJ patients. The designed decision tree allows clinicians to assess individual surgical approaches for MRONJ treatment in accordance with patient-centered outcomes and surgical skills.

Keywords: MRONJ management; MRONJ surgical treatment; oral flaps; reconstructive surgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Cone beam-computed tomography showing the necrotic bone extension in a panoramic view with and without zoom, 3D rendering and cross-sectional view.
Figure 2
Figure 2
Clinical appearance of stage 1a MRONJ according to the the Italian Society of Maxillofacial Surgery (SICMF) and the Italian Society of Oral Pathology and Oral Medicine (SIPMO) staging system (absence of signs of infection/inflammation).
Figure 3
Figure 3
Sub-marginal resection performed using piezoelectric device.
Figure 4
Figure 4
Revision of the cavity until observation of bleeding bone.
Figure 5
Figure 5
Resected sequestrum and extracted involved tooth.
Figure 6
Figure 6
Suture with interrupted points to secure primary healing in order to avoid dehiscence.
Figure 7
Figure 7
Healing without complications.
Figure 8
Figure 8
MRONJ “ghost socket” of the upper jaw as shown in 3D rendering, and coronal view of a cone beam computed tomography (CBCT) scan.
Figure 9
Figure 9
Maxillary osteonecrosis of the jaw at the time of diagnosis.
Figure 10
Figure 10
Intraoperative aspect.
Figure 11
Figure 11
Intraoperative aspect after the removal of necrotic bone.
Figure 12
Figure 12
Resected bone segment.
Figure 13
Figure 13
Tension-free advancement of the mucoperiosteal flap.
Figure 14
Figure 14
Evidence of mucosal healing.
Figure 15
Figure 15
Decision tree.
See this image and copyright information in PMC

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