Tian M, Wang D N, Luo S Y, Zhai Y W, Sun G W
Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China.
Zhonghua Kou Qiang Yi Xue Za Zhi. 2021 May 9;56(5):447-451. doi: 10.3760/cma.j.cn112144-20210119-00030.
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.
探讨上颌骨药物性颌骨坏死（MRONJ）的手术治疗方法及临床效果。回顾性分析2013年1月至2020年10月在南京大学医学院附属口腔医院口腔颌面外科接受手术治疗的28例上颌骨MRONJ患者的临床资料，包括性别、年龄、病变分期、治疗方法及预后等。其中男性20例，女性8例。发病平均年龄为（65.6±11.1）岁。根据美国口腔颌面外科医师协会指南，将患者病变分为2期或3期。10例2期病变患者行部分颌骨切除术后严密缝合，其中4例病变直接用黏骨膜瓣缝合，4例病变用邻近瓣覆盖，2例病变用颊脂垫瓣和邻近瓣覆盖。18例3期病变患者行死骨摘除术并建立引流通道。术后对患者进行定期随访，根据临床表现、局部口腔检查、影像学检查等临床标准判断手术治疗效果。随访12至52个月，2期患者术后疼痛评分（1.20±2.53）显著低于术前疼痛评分（6.70±0.95）（<0.05）。8例患者黏膜完全愈合，无新死骨形成。2例患者复发，复诊时进展为3期。18例3期病变患者在摘除死骨后建立了引流通道。术后随访时间为2至67个月，炎症和感染症状消失。术后疼痛评分（3.40±0.51）显著低于术前疼痛评分（7.06±1.00）（<0.05）。上颌骨部分切除术后软组织瓣关闭创口是治疗上颌骨MRONJ 2期病变的有效方法，而上颌骨3期病变在摘除死骨后建立通畅引流可消除临床症状，提高生活质量。
