A Clinical Retrospective Study of Surgical Treatment for Medication-Related Osteonecrosis of the Jaw

The purpose of this study was to confirm the success rate of surgical treatment of medication-related osteonecrosis of the jaw (MRONJ) in patients at a single institution (Association of Oral and Maxillofacial Surgery (AAOMS) stages 1, 2, or 3), and to identify the factors that influence treatment outcomes. As a result of analyzing the outcomes of treatment, surgical “success” was achieved in 93.97% (109) of cases, and “failure” was observed at 6.03% (7) cases. Analysis of patient factors that potentially affect treatment outcomes showed that zoledronate dose (p = 0.005) and the IV (intravenous) injection of drugs (p = 0.044) had significant negative impacts.

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Different Presentation and Outcomes in the Surgical Treatment of Advanced MRONJ in Oncological and Nononcological Patients Taking or Not Corticosteroid Therapy

BioMed Research International ◽

10.1155/2021/7855497 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Paolo Garzino Demo ◽

Alessandro Bojino ◽

Fabio Roccia ◽

Maria Chiara Malandrino ◽

Stefan Cocis ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Surgical Treatment ◽

Treatment Outcomes ◽

Corticosteroid Therapy ◽

Good Practice ◽

Maxillofacial Surgery ◽

Osteonecrosis Of The Jaw ◽

Severe Side Effect ◽

Antiresorptive Drugs

Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect caused by antiangiogenic antiresorptive drugs used to treat various oncological and non oncological diseases. The clinical and radiological characteristics of MRONJ depend on the type of causative drug, the time of administration, and its dosage. Proven systemic risk factors like anemia, uncontrolled diabetes, corticosteroid therapy, and chemotherapy in neoplastic diseases (e.g., high doses of methotrexate up to 30 mg daily) significantly increase the chances of acquiring MRONJ. The risk factors themselves can affect treatment outcomes. Although the main scientific societies have recently disseminated good practice rules on the patient’s prevention, diagnosis, and management, there are still no guidelines on shared therapeutic strategies. In general, if conservative treatment fails, surgical treatment is considered, including local debridement, osteoplasty, and marginal or segmental osteotomy. In literature, cohorts of heterogeneous patients with MRONJ have been analyzed for a long time, resulting in a lack of uniformity of information and difficulties interpreting the data. According to the American Association of Oral and Maxillofacial Surgeons criteria, this retrospective study evaluates the surgical treatment outcomes of 64 patients with stage II-III MRONJ, evaluated at the Department of Maxillofacial Surgery of the University of Turin (Italy). The first objective of this retrospective study is to evaluate treatment results for stages II-III in all cases; the second objective is to evaluate the same results by dividing the sample into different cohorts of patients: first, based on the underlying pathology, i.e., oncological and non oncological, and secondly, based on the drug or combination of drugs they took.

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Intra-articular calcaneal fractures. Retrospective study of surgical treatment vs conservative.

10.26226/morressier.570fc33ed462b8029237ee3b ◽

2016 ◽

Author(s):

Sandra Catalán Amigo

Keyword(s):

Retrospective Study ◽

Surgical Treatment ◽

Calcaneal Fractures

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The Dose of Somatostatin Analogues during Pre-Surgical Treatment Is a Key Factor to Achieve Surgical Remission in Acromegaly

Endocrines ◽

10.3390/endocrines2030023 ◽

2021 ◽

Vol 2 (3) ◽

pp. 241-250

Author(s):

Marta Araujo-Castro ◽

Eider Pascual-Corrales ◽

Héctor Pian ◽

Ignacio Ruz-Caracuel ◽

Alberto Acitores Cancela ◽

...

Keyword(s):

Retrospective Study ◽

Surgical Treatment ◽

Surgical Outcomes ◽

Pituitary Adenomas ◽

Somatostatin Analogues ◽

Beneficial Effects ◽

Key Factor ◽

Long Acting ◽

First Time ◽

Endocrine Complications

Purpose: to determine whether pre-surgical treatment using long-acting somatostatin analogues (SSAs) may improve surgical outcomes in acromegaly. Methods: retrospective study of 48 patients with acromegaly operated by endoscopic transsphenoidal approach and for first time. Surgical remission was evaluated based on the 2010 criteria. Results: most patients, 83.3% (n = 40), harbored macroadenomas and 31.3% (n = 15) invasive pituitary adenomas. In this case, 14 patients were treated with lanreotide LAR and 6 with octreotide LAR, median monthly doses of 97.5 [range 60–120] and 20 [range 20–30] mg, respectively, for at least 3 months preoperatively. Presurgical variables were comparable between pre-treated and untreated patients (p > 0.05). Surgical remission was more frequent in those pre-treated with monthly doses ≥90 mg of lanreotide or ≥30 mg of octreotide than in untreated or pre-treated with lower doses (OR = 4.64, p = 0.025). However, no differences were found between pre-treated and untreated patients when lower doses were included or between those treated for longer than 6 months compared to those untreated or pre-treated for shorter than 6 months. Similarly, no differences were found either in terms of surgical or endocrine complications (OR = 0.65, p = 0.570), independently of the doses and the duration of SSA treatment (p > 0.05). Conclusions: the dose of SSAs is a key factor during pre-surgical treatment, since the beneficial effects in surgical remission were observed with monthly doses equal or higher than 90 mg of lanreotide and 30 mg of octreotide, but not with lower doses.

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A Comparison of the Clinical and Radiological Extent of Denosumab (Xgeva®) Related Osteonecrosis of the Jaw: A Retrospective Study

Journal of Clinical Medicine ◽

10.3390/jcm10112390 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2390

Author(s):

Zineb Assili ◽

Gilles Dolivet ◽

Julia Salleron ◽

Claire Griffaton-Tallandier ◽

Claire Egloff-Juras ◽

...

Keyword(s):

Retrospective Study ◽

Cumulative Incidence ◽

Side Effect ◽

Osteonecrosis Of The Jaw ◽

Exposed Group ◽

Severe Side Effect ◽

Dental Arch ◽

P Value ◽

The Difference ◽

Bone Exposure

Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect of antiresorptive medication. The aim of this study was to evaluate the incidence of denosumab-related osteonecrosis of the jaw and to compare the clinical and radiological extent of osteonecrosis. A retrospective study of patients who received Xgeva® at the Institut de Cancérologie de Lorraine (ICL) was performed. Patients for whom clinical and radiological (CBCT) data were available were divided into two groups: “exposed” for patients with bone exposure and “fistula” when only a fistula through which the bone could be probed was observed. The difference between clinical and radiological extent was assessed. The p-value was set at 0.05, and a total of 246 patients were included. The cumulative incidence of osteonecrosis was 0.9% at 6 months, 7% at 12 months, and 15% from 24 months. The clinical extent of MRONJ was significantly less than their radiological extent: in the “exposed” group, 17 areas (45%) were less extensive clinically than radiologically (p < 0.001) and respectively 6 (67%) for the “fistula” group (p < 0.031). It would seem that a CBCT is essential to know the real extent of MRONJ. Thus, it would seem interesting to systematically perform a CBCT during the diagnosis of MRONJ, exploring the entire affected dental arch.

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Denosumab-related osteonecrosis of the jaw after tooth extraction and the effects of a short drug holiday in cancer patients: a multicenter retrospective study

Osteoporosis International ◽

10.1007/s00198-021-05995-3 ◽

2021 ◽

Author(s):

T. Hasegawa ◽

◽

N. Ueda ◽

SI. Yamada ◽

S. Kato ◽

...

Keyword(s):

Retrospective Study ◽

Cancer Patients ◽

Tooth Extraction ◽

Osteonecrosis Of The Jaw ◽

Drug Holiday

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Characteristics of patients with osteonecrosis of the jaw with oral versus intravenous bisphosphonate treatment

Maxillofacial Plastic and Reconstructive Surgery ◽

10.1186/s40902-021-00310-w ◽

2021 ◽

Vol 43 (1) ◽

Author(s):

Seung-Hun Lee ◽

So-Young Choi ◽

Min-Su Bae ◽

Tae-Geon Kwon

Keyword(s):

Retrospective Study ◽

Clinical Characteristics ◽

Demographic Data ◽

Osteonecrosis Of The Jaw ◽

Group Differences ◽

Bisphosphonate Treatment ◽

Administration Route ◽

Lesion Number ◽

Different Characteristics ◽

Intravenous Bisphosphonate

Abstract Purpose This retrospective study was aimed to evaluate the clinical characteristics and treatment outcomes in patients with osteonecrosis of the jaw who were receiving oral versus intravenous (IV) bisphosphonate (BP). Materials and methods This retrospective study enrolled subjects who had been diagnosed with medication-related osteonecrosis of the jaw (MRONJ) during the period from July 2010 to June 2014. Information regarding the following demographic and clinical characteristics was collected: demographic data, administration route and type of BP, duration of BP medication, primary disease, number of involved sites, location of the lesion, number of surgeries, outcome of treatments, and laboratory test. All the patients were divided into oral and IV BP groups; and the between-group differences were compared. Results Total 278 patients were divided into two groups as per the route of BP administration. The proportion of oral BP-related MRONJ group were more dominant over IV BP group (oral BP, n = 251; IV BP, n = 27). In the IV BP group, the average dosing duration (31.4 months) was significantly shorter than that in the oral BP group (53.1 months) (P < 0.001). The average number of involved sites in the oral BP group (1.21 ± 0.48) was smaller than that in the IV BP group (1.63 ± 0.84) (P < 0.001). The average number of surgeries was higher in the IV BP group (1.65 ± 0.95) as compared to that in the oral BP group (0.98 ± 0.73) (P < 0.001). Outcome after the surgery for MRONJ after IV BP was poor than oral BP group. Conclusion IV administration of BP causes greater inhibition of bone remodeling and could lead more severe inflammation. Therefore, even if the duration of IV administration of BP is shorter than that of oral BP, the extent of the lesion could be more extensive. Therefore, the result suggests that the MRONJ after IV BP for cancer patients needs to be considered as different characteristics to oral BP group for osteoporosis patents.

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