Evaluation of segmental mandibular resection without microvascular reconstruction in patients affected by medication-related osteonecrosis of the jaw: a systematic review

R Sacco; G Umar; R C Guerra; O Akintola

doi:10.1016/j.bjoms.2020.12.014

Evaluation of segmental mandibular resection without microvascular reconstruction in patients affected by medication-related osteonecrosis of the jaw: a systematic review

Br J Oral Maxillofac Surg. 2021 Jul;59(6):648-660. doi: 10.1016/j.bjoms.2020.12.014. Epub 2020 Dec 24.

Authors

R Sacco¹, G Umar², R C Guerra³, O Akintola²

Affiliations

¹ Oral Surgery Department, Division of Dentistry, School of Medicine, The University of Manchester, Manchester, ML13 9PL, UK; Eastman Dental Institute - University College of London, London, WC1X 8LT, UK; Oral Surgery Department, King's College Hospital, London, UK. Electronic address: r.sacco@ucl.ac.uk.
² Oral Surgery Department, King's College Hospital, London, UK.
³ Oral and Maxillofacial Surgery Department at Hospital Leforte, São Paulo, Brazil; Oral and Maxillofacial Surgery Department at Hospital Cristovão da Gama, Santo André, Brazil.

PMID: 34023155
DOI: 10.1016/j.bjoms.2020.12.014

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a severe condition that affects the jaw in patients exposed to specific drugs. More often it has been described in association with bisphosphonates (BP), but nowadays it has been observed with the use of other medications, such as denosumab (a RANK ligand inhibitor and monoclonal antibody agent) and antiangiogenic drugs. Managing the condition has unfortunately proven difficult and still remains a major challenge for clinicians and surgeons. The aim of this systematic review was to identify and analyse the evidence on mandibular segmental resection in patients with advanced MRONJ. A multi-database (PubMed, MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials) systematic search was performed. Any type of study on human patients treated with antiresorptive and antiangiogenic drugs was considered. The primary aim was to understand the success of mandibular segmental resection in the short, medium, and long term, and to understand its effects before, during, and after the operation. The search yielded 11 studies that were eligible for analysis with a total of 67 patients. Of the 11 studies, seven reported no complications, and overall, postoperative complications were seen in 16 cases. Recurrence of osteonecrosis was reported in one study. The most common postoperative complication was removal of hardware (n = 11). The mean (SD) follow-up time for eight studies was 35.57 (17.73) months. According to the limited data available in the literature, mandibular segmental resection is a viable treatment that has been used successfully in patients with various stages of MRONJ. The data show a relatively high percentage of recurrence. Additional data based on a larger cohort of patients or case-control studies are necessary to justify routine use of this type of intervention in patients affected by the condition.

Keywords: antiangiogenic drugs; antiresorptive drugs; medication-related osteonecrosis of the jaw; osteonecrosis; reconstruction; resection.

Publication types

Review
Systematic Review

MeSH terms

Angiogenesis Inhibitors / adverse effects
Bisphosphonate-Associated Osteonecrosis of the Jaw* / surgery
Bone Density Conservation Agents* / adverse effects
Diphosphonates / therapeutic use
Humans
Neoplasms*
Osteonecrosis* / chemically induced
Osteonecrosis* / surgery

Substances

Angiogenesis Inhibitors
Bone Density Conservation Agents
Diphosphonates