Conservative surgical management of stage III medication-related osteonecrosis of the jaw in the mandible: A retrospective study with particular emphasis on anterior mandible.

BACKGROUND/PURPOSE: Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication associated with anti-resorptive therapy, and surgical intervention remains an effective treatment strategy regardless of disease stage. While extensive surgical resection is considered the standard approach for advanced-stage MRONJ, it may not be suitable for elderly patients or those with systemic comorbidities. This study evaluated the outcomes of conservative surgical management in patients with stage III MRONJ affecting the anterior mandible.

MATERIALS AND

METHODS

A retrospective study was conducted on patients with stage III MRONJ of the anterior mandible. All patients underwent conservative surgical treatment, including sequestrectomy, debridement of inflamed soft tissue, and bone curettage. Clinical outcomes, radiographic bone healing, and long-term follow-up data were analyzed.

RESULTS

Among 77 patients with MRONJ of the mandible, four with advanced stage III MRONJ involving the inferior border and genial tubercle were included. Two patients underwent conventional conservative surgical treatment, while two patients with preoperative pathologic fractures underwent stabilization with a reconstruction plate and conservative surgical treatment. The mean follow-up period was 41.5 months, and no recurrence, mandibular fractures, or mechanical failure of the reconstruction plate was observed. Radiographic findings demonstrated restoration of mandibular structural integrity and reinforcement throughout the follow-up period.

CONCLUSION

Conservative surgical management may be a viable alternative to extensive resection in stage III MRONJ of the anterior mandible, particularly when aggressive surgical resection is not feasible. Preserving viable bone is essential for bone healing and functional recovery, and thorough intraoperative assessment is crucial for achieving successful treatment outcomes.