[A retrospective study of pedicled flaps for repair of oral mucosal defects in patients with medication-related osteonecrosis of the jaw].

Objective

To investigate the clinical efficacy of pedicled flaps for repairing oral mucosa defects in medication-related osteonecrosis of the jaw (MRONJ), and to analyze the indications for different types of pedicled flaps.

Methods

The clinical data of 158 MRONJ patients who met the inclusion criteria and were admitted to the Department of Maxillofacial Trauma and Orthognathic Surgery, Hospital of Stomatology, Air Force Medical University from January 2019 to December 2024 were retrospectively analyzed, including 74 males (46.8%) and 84 females (53.2%).The age was (59.2±10.7) years (range, from 20 to 87 years old). According to the method of soft tissue repair, the patients were divided into direct suture group (61 cases) and pedicled tissue flap group (97 cases, including 80 cases of buccal fat pad flap and 17 cases of submental island flap). The rate of secondary operation was compared between the two groups. Multivariate binary Logistic regression and subgroup analysis were used to evaluate the efficacy and influencing factors of pedicled tissue flaps, and the comparison between the buccal fat pad flap and submental island flap was performed.

Results

The median follow-up time was 36 months. Univariate analysis showed that the secondary operation rate was 68.9% (42/61) in the direct suture group, which was significantly higher than 16.5% (16/97) in the pedicled tissue flap group (P<0.001). After adjusting for confounding factors such as age and lesion location, multivariate Logistic regression analysis showed that pedicled tissue flap was an independent protective factor against the risk of secondary surgery (OR=0.049, P<0.001). Stage 3 disease was an independent risk factor for secondary surgery (OR=8.455, P=0.002). Subgroup analysis showed that the secondary operation rate of pedicled tissue flap was significantly lower than that of direct suture in stage 3 group, mandibular group,<65 years group, male group and female group (all P<0.05). There was no significant difference among stage 2 group, maxillary group and ≥65 years group (all P>0.05), but the trend of protection was the same. The secondary operation rate was 17.5% (14/80) in the buccal fat pad flap group and 2/17 in the submental island flap group. There was no significant difference between the two groups (P=0.730).

Conclusions

The use of pedicled tissue flap for repairing oral mucosal wounds can significantly reduce the risk of secondary surgery for MRONJ, and the effect is superior to direct suture. Buccal fat pad flap is the first choice for maxillary and retromolar mucosal defects, and submental island flap can be used for large mandibular mucosal defects.