GP4b - Efficacy of Local Wound Care in Patients With MRONJ

Abstract:

Objective: Medication-related osteonecrosis of the jaw (MRONJ) remains a challenging complication associated with antiresorptive therapy. Treatment options include both nonsurgical approaches such as local wound care (LWC) and surgical interventions. This study aims to evaluate the success rates of LWC and surgical treatment in our patient cohort. Secondary outcomes included staging MRONJ lesions and the duration of discontinuation of antiresorptive therapy at the time of initial presentation.

Methods: A retrospective analysis was conducted on 51 patients undergoing LWC for MRONJ; 76% of patients had stage 1 lesions and 24% had stage 2 lesions. LWC was defined by mechanical cleaning of the exposed bone or fistula with chlorhexidine 0.12% using a toothbrush or cotton swab, as described by Hadaya et al.¹ All patients underwent LWC for at least one month. LWC was aborted in cases of persistent signs and symptoms of infection, progressive bone destruction, lack of clinical improvement, or other factors (eg, patient preference for surgery, oncologist requirement for disease resolution prior to chemotherapy). Healed MRONJ lesions were defined by mucosal closure without signs or symptoms of infection or exposed bone at the time of evaluation. Surgical management was determined on a case-by-case basis and included the use of cone beam computed tomography, nuclear imaging, and adjunctive modalities such as local flaps, neuroplasty, hyperbaric oxygen therapy, platelet-derived growth factor, and microvascular fibula grafts. Statistical analyses included chi-square testing and a z-test for proportions to compare LWC and surgical success rates. A significance threshold of P < .05 was applied. Data on drug holidays were collected for 49 patients.

Results: In our retrospective study, LWC was successful in 7 (13.7%) patients, whereas 31 patients (90.3%) undergoing primary surgery achieved complete healing (P < .0001), with 3 patients refusing a second surgery. The average duration of drug holiday at the time of presentation for 49 patients with MRONJ was 8.26 months.

Conclusion: Our findings suggest that LWC alone may be less effective than previously reported, with surgical management demonstrating significantly higher success rates. Our results highlight the need for further research to assess factors influencing LWC efficacy and to refine patient selection criteria for nonsurgical management. Surgical intervention remains the most reliable treatment for MRONJ in our cohort.

References:
1. Hadaya D, Soundia A, Freymiller E, et al. Nonsurgical management of medication-related osteonecrosis of the jaws using local wound care. J Oral Maxillofac Surg. 2018;76:2332-2339.
2. Ristow O, Ruckschlob T, Muller M, et al. Is conservative non-surgical management of medication osteonecrosis of the jaw an appropriate treatment option for early stages? A long-term single-center cohort study. J Cranio-Maxillo-Facial Surgery. 2019;47:491-499.
Disease resolution success rate between local wound care (LWC) and surgery