[Effect of the surgical treatment of maxillary medication-related osteonecrosis of the jaw].

To explore the methods and clinical effects of the surgery for treating maxillary medication-related osteonecrosis of the jaw (MRONJ). The clinical data including gender, age, stage of lesion, treatment method and prognosis of 28 patients with maxillary MRONJ who underwent surgical treatment in the Department of Oral and Maxillofacial Surgery of Medical School of Nanjing University from January 2013 to October 2020 were retrospectively analyzed. There were 20 males and 8 females. The mean age at onset was (65.6±11.1) years old. According to the guidelines of American Association of Oral and Maxillofacial Surgeons, the patients' lesions were divided into 2 or 3 stages. Ten cases of stage 2 lesions were tightly sutured after partial jaw resection. Among them, 4 lesions were sutured directly with mucoperiosteal flaps, 4 lesions were covered by adjacent flaps and 2 lesions was covered by buccal fat pad flaps and adjacent flaps. Eighteen cases of stage 3 lesions were treated with sequestrectomy and drainage channels were formed. Patients were followed up regularly after the surgery, and the effect of surgical treatment was judged according to the clinical criteria such as clinical manifestations, local oral examination, imaging examination etc. After follow-up for 12 to 52 months, the postoperative pain score (1.20±2.53) was significantly lower than preoperative pain score (6.70±0.95) (<0.05) in stage 2 patients. Eight patients' mucosa healed completely without new dead bone formed. Two patients had recurrence and developed to stage 3 at the time of revisit. There were 18 cases of stage 3 lesions, which formed drainage channels after removal of the dead bone. The postoperative follow-up time was 2 to 67 months, and the symptoms of inflammation and infection disappeared. Postoperative pain score (3.40±0.51) was significantly lower than preoperative pain score (7.06±1.00) (<0.05). Soft tissue flap closure of wound after partial maxillectomy is an effective approach for the treatment of maxillary MRONJ stage 2 lesions, while maxillary stage 3 lesions could be treated for eliminating clinical symptoms and improving the quality of life when establishing unobstructed drainage after dead bone extraction.