Guo Yuxing, Zhao Ning, Wang Diancan, Wang Yang, Guo Chuanbin
Dept. of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China.
National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices ＆ Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China.
Hua Xi Kou Qiang Yi Xue Za Zhi. 2022 Jan 25;40(1):61-67. doi: 10.7518/hxkq.2022.01.009.
This study aimed to analyze the clinical application effect of the double-layer soft tissue closure technique (DLST) based on pedicled buccal fat pad in repairing maxillary defects after medication-related osteonecrosis of the jaw (MRONJ) surgery.
Ten patients with maxillary MRONJ were diagnosed and treated via DLST based on pedicled buccal fat pad. Partial maxillary resection was conducted to remove the MRONJ lesion, and the inflammatory soft tissue in the maxillary sinus cavity was removed but the maxillary sinus mucosa was retained. Patients also underwent resection of the lower segment of the sphenoid pterygoid process. A pedicled buccal fat pad was used to line the maxillary sinus floor and oral mucosa to achieve double-layer soft tissue closure of the wound. The characteristics of the medication for the primary disease, the clinical characteristics and imaging characteristics of osteonecrosis, the surgical treatment effects, pain score, and functional status evaluation of the 10 patients were all reviewed and analyzed.
Among the 10 patients, there were 5 cases of breast cancer, 2 cases of lung cancer, 1 case of prostate cancer, 1 case of multiple myeloma, and 1 case of kidney cancer. All 10 patients received zoledronic acid, and the average time of application of zoledronic acid was 34 months. Six patients had upper jaw exposure, and 4 patients had gingival soft tissue fistula; the average time to clinical symptoms was 5.6 months. Among them, 5 patients had a history of tooth extraction, 3 patients with apical periodontitis, 1 patient with periodontitis, and 1 patient with spontaneous teeth loss. The lesions of 10 patients were all located in the maxillary posterior area. CT images can often show sequestration near the maxillary sinus floor, and the maxillary sinus cavity was full of soft tissue inflammation in most patients. During the follow-up period, 8 patients healed by the first intention, and the other patient had partial liquefaction of the buccal fat pad 2 weeks after the operation, and the oral mucosa fistula closed 1 month after the operation. In another patient, MRONJ symptoms recurred 2 months after the operation, and the surgical site occasionally swelled and discharged pus. The patient's symptoms were completely relieved after another operation. The patient's pain and functional status improved significantly after the operation.
Maxillary MRONJ is commonly found in the posterior area. The buccal fat pad-based DLST is used to repair the defect after maxillary resection, which is beneficial to seal the oral-maxillary sinus fistula and improve the clinical symptoms of patients with MRONJ.
本研究旨在分析基于带蒂颊脂垫的双层软组织闭合技术（DLST）在药物相关性颌骨坏死（MRONJ）手术后修复上颌骨缺损中的临床应用效果。
对10例上颌骨MRONJ患者采用基于带蒂颊脂垫的DLST进行诊断和治疗。进行部分上颌骨切除术以切除MRONJ病变，切除上颌窦腔内的炎性软组织，但保留上颌窦黏膜。患者还接受了翼突下颌缘下段切除术。使用带蒂颊脂垫衬于上颌窦底和口腔黏膜，实现伤口的双层软组织闭合。回顾分析了10例患者的原发疾病用药特点、骨坏死的临床特征和影像学特征、手术治疗效果、疼痛评分及功能状态评估。
10例患者中，乳腺癌5例，肺癌2例，前列腺癌1例，多发性骨髓瘤1例，肾癌1例。10例患者均接受了唑来膦酸治疗，唑来膦酸平均应用时间为34个月。6例患者上颌骨暴露，4例患者牙龈软组织瘘；出现临床症状的平均时间为5.6个月。其中，5例患者有拔牙史，3例患者有根尖周炎，1例患者有牙周炎，1例患者有牙齿自发脱落。10例患者的病变均位于上颌骨后部区域。CT图像常显示上颌窦底附近有死骨形成，大多数患者上颌窦腔内充满软组织炎症。随访期间，8例患者一期愈合，另1例患者术后2周颊脂垫部分液化，术后1个月口腔黏膜瘘闭合。另1例患者术后2个月MRONJ症状复发，手术部位偶尔肿胀、流脓。再次手术后患者症状完全缓解。术后患者的疼痛和功能状态明显改善。
上颌骨MRONJ常见于后部区域。基于颊脂垫的DLST用于修复上颌骨切除术后的缺损，有利于封闭口腔 - 上颌窦瘘，改善MRONJ患者的临床症状。
