[Surgical treatment outcomes of different stages of maxillary medication-related osteonecrosis of the jaw].

OBJECTIVE: To evaluate the surgical outcomes of maxillary medication-related osteonecrosis of the jaw (MRONJ) at different disease stages and to analyze the comparative efficacy of different surgical techniques on the prognosis of stage Ⅲ patients.

METHODS: A detailed retrospective analysis was conducted on the clinical data of 136 patients with maxillary MRONJ who underwent surgical treatment in the Department of Oral and Maxillofacial Surgery of Peking University School and Hospital of Stomatology from April 2014 to February 2024. All patients were rigorously classified according to the 2022 American Association of Oral and Maxillofacial Surgeons (AAOMS) staging criteria: Stage Ⅰ (n=8), stage Ⅱ (n=30), and stage Ⅲ (n=98). The surgical interventions included local lesion resection with primary direct closure, buccal fat pad packing, and iodoform gauze packing. The patients were systematically followed up for a period of 1 year postoperatively to comprehensively assess several key outcome measures: Complete mucosal healing, resolution of pain, effective infection control, and radiological improvement of maxillary sinus inflammation based on serial computed tomography scans. Statistical analysis was performed using SPSS version 20.0. Continuous variables were expressed as mean±standard deviation and compared using the t-test, while categorical variables were expressed as numbers and percentages and compared using the χ2 test or Fisher' s exact test as appropriate. A P-value < 0.05 was considered statistically significant for all analyses.

RESULTS: The overall short-term (3 months) cure rate was 91.2% (124/136), which improved to a long-term (1 year) cure rate of 94.9% (129/136). A stage-stratified analysis revealed excellent long-term cure rates: 100.0% (8/8) for stage Ⅰ, 96.7% (29/30) for stage Ⅱ, and 93.9% (92/98) for stage Ⅲ, with no statistically significant difference in outcomes across the different stages (P=0.611). Among the 98 stage Ⅲ patients, 34 were treated with buccal fat pad transfer (BFPT group) and 64 with iodine strip packing (ISP group), with no significant differences in baseline demographic or clinical characteristics between the two groups, ensuring comparability. The BFPT group demonstrated a statistically significant superior performance in achieving oroantral fistula closure both at the short-term (79.4% vs. 23.4%, P < 0.001) and long-term (85.3% vs. 54.7%, P=0.002) follow-up assessments. In contrast, the ISP group showed a markedly greater degree of improvement in maxillary sinus inflammation, as quantified by a standardized radiographic scoring system, with significantly greater reductions in inflammation scores at both the 3-month (P=0.029) and 12-month (P=0.014) follow-up intervals.

CONCLUSION: Surgical management of maxillary MRONJ results in high rates of success with a favorable complication profile. For advanced (stage Ⅲ) disease, the choice of surgical technique entails a strategic trade-off: The buccal fat pad procedure is more conducive to achieving reliable soft tissue closure and oroantral fistula resolution, whereas iodoform gauze packing provides superior management and resolution of concomitant maxillary sinusitis. Consequently, the selection of surgical technique should be individualized, based on a careful consideration of the patient's specific anatomical defect, the extent of sinus involvement, and their overall clinical condition.