A Clinical Study Of Segmental Mandibulectomy For Medication-Related Osteonecrosis Of The Jaw

Abstract Purpose Few studies have focused on segmental mandibulectomy for the surgical treatment of patients with medication-related osteonecrosis of the jaw (MRONJ). The purpose of this retrospective study was to investigate the extent of mandibular resection required and the treatment outcomes. Methods One hundred thirty-seven patients with MRONJ who underwent surgical treatment at the Nagasaki University Hospital between 2011 and 2019 were included in the study. A total of 168 surgeries (155 marginal mandibulectomies; 13 segmental mandibulectomies) were performed. The relationship between various clinical and imaging factors and the treatment outcomes were investigated in the 13 cases of segmental mandibulectomy. Results Preoperative computed tomography revealed osteolytic lesions (13/13), periosteal reaction (PR; 12/13), and osteosclerosis (12/13) in patients who underwent segmental mandibulectomies. Postoperative CT revealed no residual osteolytic lesions and PR, although osteosclerosis persisted in nine patients. The cure rate of segmental mandibulectomy was 92.3% (12/13), whereas that of marginal mandibulectomy was 67.1% (104/155). One patient relapsed after segmental mandibulectomy was cured by additional resection. Two and four patients received reconstruction with free fibula flap and reconstruction metal plate, respectively; seven patients did not undergo reconstructive surgery in consideration of their poor general condition or will. Finally, in all the 13 patients, clinical symptoms such as pain and purulent discharge disappeared and oral intake was possible. Conclusion Considering the end-of-life care, segmental mandibulectomy is a treatment option for refractory MRONJ, because it can eliminate clinical symptoms early. When segmental mandibulectomy is performed, the area involving osteolytic lesions and PR must be included.