Retrospective analysis of treatment strategies for advanced medication-related osteonecrosis of the maxilla

doi:10.19438/j.cjoms.2026.05.009

Abstract

Abstract: PURPOSE: To explore effective therapeutic strategies and prognosis for advanced medication-related osteonecrosis of the jaw (MRONJ) in the maxilla, and to provide evidence for standardized clinical management. METHODS: A retrospective analysis was performed on 74 patients with stage Ⅱ and Ⅲ maxillary MRONJ treated in Affiliated Hospital of Medical School, Nanjing University from January 2022 to December 2025. All patients received preoperative preparation including alternating mouth rinses with chlorhexidine gluconate and 1% hydrogen peroxide, systemic hyperthermia, and antibiotic prophylaxis. Surgical methods were selected according to the staging: 43 patients with stage Ⅱ underwent maxillary alveolectomy; 31 patients with stage Ⅲ underwent partial maxillectomy, subtotal maxillectomy, or local anesthesia-guided sequestrectomy combined with maxillary sinus fenestration. Among them, 23 cases were repaired with pedicled buccal fat pad flap combined with double-layer soft tissue closure technique. Postoperative regular follow-up was performed to observe wound healing and complications. RESULTS: The 74 patients were followed up for 3 to 48 months, with an average of 25.8 months. Among 68 patients undergoing surgery under general anesthesia, 65 cases (95.6%) achieved complete mucosal healing with resolution of clinical symptoms and absence of new sequestrum formation. Postoperatively, adverse outcomes were observed in only 3 cases: 1 case involved a simple recurrence of MRONJ, and 2 cases involved simple concurrent oral-maxillary sinus fistulas. No instances of postoperative recurrence combined with maxillary sinus fistula were reported. The 6 patients who underwent local anesthesia surgery experienced pain relief and improved osteomyelitis symptoms; all 23 cases repaired with buccal fat pad flap successfully closed the oroantral communication. CONCLUSIONS: For patients with stage Ⅱ and Ⅲ maxillary MRONJ, stage tailored surgical procedures (alveolectomy, partial or subtotal maxillectomy, etc.) combined with pedicled buccal fat pad flap transfer and double-layer closure can effectively promote wound healing, reduce recurrence, and lower the incidence of complications.

Key words: Maxillary medication-related osteonecrosis, Personalized surgical plan, Buccal fat pad flap repair, Double-layer soft tissue closure, Prognosis analysis

CLC Number:

R782.3

Wu Zhuhao, Sun Yawei, He Jinyuan, Li Fuyan, Xu Huixia, Cao Ting, Jiang Chenxi, Zhao Xulong, Sun Guowen. Retrospective analysis of treatment strategies for advanced medication-related osteonecrosis of the maxilla[J]. China Journal of Oral and Maxillofacial Surgery, 2026, 24(5): 494-500.

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