Lemound Juliana, Muecke Thomas, Zeller Alexander-Nicolai, Lichtenstein Jürgen, Eckardt André, Gellrich Nils-Claudius
Consultant, Department of Oral and Maxillofacial Surgery, Klinikum Darmstadt, Darmstadt, Germany.
Head, Department of Oral and Maxillofacial Surgery, Malteser Klinikum Krefeld-Uerdingen and Duisburg Homberg, Krefeld, Germany.
J Oral Maxillofac Surg. 2018 Apr;76(4):877-885. doi: 10.1016/j.joms.2017.09.021. Epub 2017 Oct 13.
Medication-related osteonecrosis of the jaw (MRONJ) is an adverse side effect of antiresorptive and antiangiogenic therapeutic agents that is difficult to treat owing to its high relapse rate. The aim of the present study was to determine whether patients with MRONJ treated using decortication and a nasolabial flap compared with those who underwent decortication with mucoperiosteal flaps have better outcomes regarding stable wound closure.
Two groups of patients with MRONJ and intraoral exposed bone were evaluated in a cohort clinical study retrospectively. The primary predictor variable was the treatment group. The experimental group used the nasolabial flap for wound closure, and the control group used the mucoperiosteal flap for closure. The outcome variable was successful wound closure defined as a symptomless and closed wound after at least 12 months. Other study variables included factors such as perioperative drug holiday, duration of postoperative oral antibiotic administration, and postoperative use of nasogastric feeding tubes. Cox proportional hazard regression analysis and Kaplan-Meier curves were used to determine the factors independently associated with the dependent variable. The Mann-Whitney U test and χ test were used for analyses regarding group-related data.
Both groups showed similar demographics. The 16 study patients receiving nasolabial flaps had a mean age of 69.9 years, and the 16 control patients receiving mucoperiosteal flaps had a mean age of 71.8 years. Both groups included 10 women and 6 men. Of the 16 patients in each group, 15 had received a bisphosphonate and 1, monoclonal antibody therapy. All evaluated patients underwent combined treatment, including decortication and intravenous antibiotics. Of the 16 patients receiving nasolabial flaps, symptomless intact wound closure was achieved in 68.8%. Of the 16 patients with mucoperiosteal closure, 18.7% achieved wound closure, with 81.2% developing a relapse of MRONJ, a statistically significant difference (P < .001). No statistically significant differences were found between the 2 groups in the demographic variables. The mean interval to relapse for the experimental and control groups was 13.6 ± 7.8 and 8.2 ± 7.9 months, respectively (P = .017).
MRONJ is a complication of antiosteoclastic treatment of mostly oncologic, palliative patients, which requires a very methodical approach to surgical treatment. A variety of different methods have been reported. The use of nasolabial flaps can be considered as a highly reliable option for coverage the bone wound with less morbidity than microvascular free flaps and better long-term results compared with mucoperiosteal flaps.
颌骨药物相关性骨坏死（MRONJ）是抗吸收和抗血管生成治疗药物的一种不良副作用，因其高复发率而难以治疗。本研究的目的是确定与采用粘骨膜瓣进行去皮质术的患者相比，采用去皮质术联合鼻唇瓣治疗的MRONJ患者在伤口稳定闭合方面是否有更好的效果。
在一项队列临床研究中，对两组患有MRONJ且口腔内有暴露骨的患者进行回顾性评估。主要预测变量是治疗组。实验组采用鼻唇瓣闭合伤口，对照组采用粘骨膜瓣闭合伤口。结局变量是成功的伤口闭合，定义为至少12个月后伤口无症状且闭合。其他研究变量包括围手术期停药、术后口服抗生素的持续时间以及术后鼻饲管的使用等因素。采用Cox比例风险回归分析和Kaplan-Meier曲线来确定与因变量独立相关的因素。采用Mann-Whitney U检验和χ检验对组相关数据进行分析。
两组患者的人口统计学特征相似。16例接受鼻唇瓣治疗的研究患者平均年龄为69.9岁，16例接受粘骨膜瓣治疗的对照患者平均年龄为71.8岁。两组均包括10名女性和6名男性。每组16例患者中，15例接受了双膦酸盐治疗，1例接受了单克隆抗体治疗。所有评估患者均接受了包括去皮质术和静脉用抗生素在内的联合治疗。16例接受鼻唇瓣治疗的患者中，68.8%实现了无症状的伤口完整闭合。16例采用粘骨膜瓣闭合的患者中，18.7%实现了伤口闭合，81.2%出现了MRONJ复发，差异有统计学意义（P <.001）。两组在人口统计学变量方面未发现统计学显著差异。实验组和对照组的平均复发间隔分别为13.6±7.8个月和8.2±7.9个月（P = 0.017）。
MRONJ是大多数肿瘤姑息治疗患者抗破骨细胞治疗的一种并发症，这需要一种非常有条理的手术治疗方法。已经报道了多种不同的方法。鼻唇瓣的使用可被视为覆盖骨伤口的一种高度可靠的选择，其发病率低于游离微血管皮瓣，与粘骨膜瓣相比长期效果更好。
