Microvascular reconstruction of medication related osteonecrosis of the head and neck

Larissa Sweeny; Sallie M Long; Patrik Pipkorn; Mark K Wax; Carissa M Thomas; Joseph M Curry; Sara Yang; Daniel Lander; Farshad Chowdhury; Dev Amin; Anne C Kane; Brett A Miles; Andrew Salama; Steven B Cannady; Kendall Tasche; Derek Mann; Ryan Jackson

doi:10.1002/hed.27653

Microvascular reconstruction of medication related osteonecrosis of the head and neck

Head Neck. 2024 Jan 31. doi: 10.1002/hed.27653. Online ahead of print.

Authors

Larissa Sweeny^{1

2}, Sallie M Long¹, Patrik Pipkorn³, Mark K Wax⁴, Carissa M Thomas⁵, Joseph M Curry⁶, Sara Yang⁴, Daniel Lander³, Farshad Chowdhury⁵, Dev Amin⁶, Anne C Kane⁷, Brett A Miles⁸, Andrew Salama⁹, Steven B Cannady¹⁰, Kendall Tasche¹⁰, Derek Mann⁶, Ryan Jackson³

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of Miami, Miami, Florida, USA.
² Surgical Care Division, Miami Veterans Affairs Health Care System, Miami, Florida, USA.
³ Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, Missouri, USA.
⁴ Oregon Health and Science University School of Medicine, Oregon, Portland, USA.
⁵ Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
⁶ Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
⁷ Department of Otolaryngology, University of Mississippi, Jackson, Mississippi, USA.
⁸ Department Otolaryngology Head and Neck Oncology, Northwell Health System, New York, New York, USA.
⁹ Division Oral and Maxillofacial Surgery, Northwell Health System, New York, New York, USA.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.

PMID: 38294050
DOI: 10.1002/hed.27653

Abstract

Background: Medication related osteonecrosis of the jaw (MRONJ) requiring free flap (FF) reconstruction is uncommon with limited reported findings.

Methods: Multicenter, retrospective case series of 49 consecutive adult patients presenting with advanced MRONJ requiring FF reconstruction from 2010 to 2022. Perioperative complications and outcomes were analyzed.

Results: Eighty-two percent (n = 40) of cases were of the mandible and 18% (n = 9) were of the maxilla. The mean follow-up was 15 months (±19.6). The majority of FF survived (96%, n = 47). FF reconstructions of the maxilla were more likely to require postoperative debridement (56%, 95% CI [27, 81%] vs. 15%, 95% CI [7, 25%], p = 0.008) or develop intraoral bone exposure (56%, 95% CI [27, 81%] vs. 18%, 95% CI [9, 27%], p = 0.02). Most patients (71%, n = 35) received preoperative antibiotics which was associated with a higher rate of FF survival (100% vs. 86%, 95% CI [60, 96%], p = 0.02) and fewer complications.

Conclusions: Patients undergoing FF reconstruction for MRONJ do well with high rates of FF success. MRONJ of the maxilla have a higher rate of some complications. Preoperative antibiotics correlated with higher FF survival and fewer postoperative complications.

Keywords: free flap; head and neck reconstruction; medication related osteonecrosis; outcomes.