Medication-related osteonecrosis of the Jaw: evaluation of a therapeutic strategy in oral surgery
2024
Natu, Mathilde | Meuric, Vincent | Roginski, Paul | Gamby, Romain | Lejeune, Sophie | Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou] | Nutrition, Métabolismes et Cancer (NuMeCan) ; Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE) | Centre d'Investigation Clinique [Rennes] (CIC) ; Université de Rennes (UR)-Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]-Institut National de la Santé et de la Recherche Médicale (INSERM) | Institut de Biologie Intégrative de la Cellule (I2BC) ; Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay-Centre National de la Recherche Scientifique (CNRS) | Clinique mutualiste La Sagesse
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Show more [+] Less [-]English. Background: Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse illness linked to antiresorptive therapies (ART), for which there is no therapeutic gold standard. Many factors can influence MRONJ evolution such as cancer type, treatment, comorbidities, and accumulated dose of ART. The aim of this study was to determine the influencing factors of MRONJ treatments success.Methods: This retrospective study focused on patients treated for MRONJ in a French tertiary centre. Non-operative therapy was always applied, ART were suspended if appropriate, and surgery (MRONJ removal and musculo-mucosal flap reconstruction) was performed in the absence of contraindication. The evaluation criteria were bone and mucosal healing 3 months after surgery.Results: 81 MRONJ were included; medical treatment alone was administered to 26% while the remaining 74% received additional surgery. Therapeutic success reached 86.7% (52/60) for surgery compared to 42.9% (9/21) for medical treatment alone (p<0.001). Age (OR=1.08, p=0.014) and the absence of infection (OR=5.32, p=0.042) were in favour of success, while medical treatment alone (OR=0.03, p<0.001) was highly unfavourable.Conclusion: MRONJ healing is influenced by age, non-infectious stages, and surgery. Additional surgery in MRONJ treatment should be advised if the health of the patient permits.
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