Nasolabial Flap improves Healing in Medication-Related Osteonecrosis of the Jaw

Publication date: Available online 13 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Juliana Lemound, Thomas Muecke, Alexander-Nicolai Zeller, Jürgen Lichtenstein, André Eckardt, Nils-Claudius Gellrich
PurposeMedication-related osteonecrosis of the jaw (MRONJ) is an adverse side effect of antiresoptive and antiangiogenic therapeutics that is difficult to treat owing to its high relapse rate. The aim of the study was to answer the question: Among patients with MRONJ, do those managed using decortication and a nasolabial flap, when compared to those managed with decortication and mucoperiosteal flaps, have better outcome respectively stable wound closure.Materials and MethodsTwo groups of patients suffering from MRONJ with intraoral exposed bone were evaluated in a cohort clinical study retrospectively. The primary predictor variable is treatment groups: The experimental group used the nasolabial flap for wound closure, whereas in control group a mucoperiosteal closure was performed. The outcome variable was a successful wound closure defined as symptomless and closed wound after at least 12 months. Other study variables were factors as perioperative drug holiday, duration of post-operative oral antibiotic administration, or post-operative use of nasogastric feeding tubes. Cox proportional hazard regression, Kaplan-Meier curves were used to determine factors independently associated with the dependent variable. Mann-Whitney-U test and χ²-test were used for analyses regarding group related data.ResultsBoth groups showed similar demographics. 16 study patients receiving nasolabial flaps had a mean age of 69.9 years, whereas 16 control patients receiving mucoperiosteal flaps had a mean age of 71.8 years. Both groups each comprised of ten women and six men. 15 patients of each group received a bisphosphonate and one patient a monoclonal antibody therapy.All evaluated patients underwent combined treatment including decortication and intravenous antibiotic treatment. 16 patients receiving nasolabial flaps showed symptomless intact wound closure in 68.8% of the cases. 16 patients with mucoperiosteal closure developed relapse of MRONJ in 81,2% of cases, yielding the control group and revealing significant differences (p<0.001). There were no significant differences between the two groups for demographic variables. The mean time to relapse for the experimental and control group was 13.6 ± 7.8 and 8.2 ± 7.9, respectively (p =0.017).ConclusionMRONJ is a complication of the antiosteoclastic treatment of mostly oncological, palliative patients, which requires a very methodical approach to surgical treatment that has been reported in a variety of different methods. Nasolabial flaps can be considered as a highly reliable option for coverage the bone wound with less morbidity as microvascular free flaps and better long term results when compared to mucoperiosteal flaps.



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