Microvascular reconstruction of medication related osteonecrosis of the head and neck
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 2...
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| Veröffentlicht in: | Head & neck 2024-08, Vol.46 (8), p.1902-1912 |
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| creator | Sweeny, Larissa Long, Sallie M. Pipkorn, Patrik Wax, Mark K. Thomas, Carissa M. Curry, Joseph M. Yang, Sara Lander, Daniel Chowdhury, Farshad Amin, Dev Kane, Anne C. Miles, Brett A. Salama, Andrew Cannady, Steven B. Tasche, Kendall Mann, Derek Jackson, Ryan |
| description | 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. |
| doi_str_mv | 10.1002/hed.27653 |
| format | Article |
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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.</description><identifier>ISSN: 1043-3074</identifier><identifier>ISSN: 1097-0347</identifier><identifier>EISSN: 1097-0347</identifier><identifier>DOI: 10.1002/hed.27653</identifier><identifier>PMID: 38294050</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Antibiotics ; Bisphosphonate-Associated Osteonecrosis of the Jaw - surgery ; Complications ; Female ; free flap ; Free Tissue Flaps ; Head and neck ; head and neck reconstruction ; Humans ; Jaw ; Male ; Maxilla ; medication related osteonecrosis ; Microvasculature ; Middle Aged ; Necrosis ; Osteonecrosis ; outcomes ; Plastic Surgery Procedures - adverse effects ; Plastic Surgery Procedures - methods ; Postoperative ; Retrospective Studies ; Survival ; Treatment Outcome</subject><ispartof>Head & neck, 2024-08, Vol.46 (8), p.1902-1912</ispartof><rights>2024 The Authors. published by Wiley Periodicals LLC.</rights><rights>2024 The Authors. Head & Neck published by Wiley Periodicals LLC.</rights><rights>2024. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3483-dfe043271cb0fd6122d6f62c33c3c7030c3b12dfc8568794c943e18de58a42ae3</cites><orcidid>0000-0002-4880-6172 ; 0000-0003-0250-8636</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fhed.27653$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fhed.27653$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38294050$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sweeny, Larissa</creatorcontrib><creatorcontrib>Long, Sallie M.</creatorcontrib><creatorcontrib>Pipkorn, Patrik</creatorcontrib><creatorcontrib>Wax, Mark K.</creatorcontrib><creatorcontrib>Thomas, Carissa M.</creatorcontrib><creatorcontrib>Curry, Joseph M.</creatorcontrib><creatorcontrib>Yang, Sara</creatorcontrib><creatorcontrib>Lander, Daniel</creatorcontrib><creatorcontrib>Chowdhury, Farshad</creatorcontrib><creatorcontrib>Amin, Dev</creatorcontrib><creatorcontrib>Kane, Anne C.</creatorcontrib><creatorcontrib>Miles, Brett A.</creatorcontrib><creatorcontrib>Salama, Andrew</creatorcontrib><creatorcontrib>Cannady, Steven B.</creatorcontrib><creatorcontrib>Tasche, Kendall</creatorcontrib><creatorcontrib>Mann, Derek</creatorcontrib><creatorcontrib>Jackson, Ryan</creatorcontrib><title>Microvascular reconstruction of medication related osteonecrosis of the head and neck</title><title>Head & neck</title><addtitle>Head Neck</addtitle><description>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.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antibiotics</subject><subject>Bisphosphonate-Associated Osteonecrosis of the Jaw - surgery</subject><subject>Complications</subject><subject>Female</subject><subject>free flap</subject><subject>Free Tissue Flaps</subject><subject>Head and neck</subject><subject>head and neck reconstruction</subject><subject>Humans</subject><subject>Jaw</subject><subject>Male</subject><subject>Maxilla</subject><subject>medication related osteonecrosis</subject><subject>Microvasculature</subject><subject>Middle Aged</subject><subject>Necrosis</subject><subject>Osteonecrosis</subject><subject>outcomes</subject><subject>Plastic Surgery Procedures - adverse effects</subject><subject>Plastic Surgery Procedures - methods</subject><subject>Postoperative</subject><subject>Retrospective Studies</subject><subject>Survival</subject><subject>Treatment Outcome</subject><issn>1043-3074</issn><issn>1097-0347</issn><issn>1097-0347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNp1kMtOwzAQRS0EgvJY8AMoEhtYBMaPxMkSlfKQitjA2nLtiRpI42InIP4ehxQWSKzGIx9fXR9CjilcUAB2uUR7wWSe8S0yoVDKFLiQ28NZ8JSDFHtkP4QXAOC5YLtkjxesFJDBhDw_1Ma7dx1M32ifeDSuDZ3vTVe7NnFVskJbG_29eWx0hzZxoUPXYnwX6jAw3RKTJWqb6NYm8eL1kOxUugl4tJkH5Plm9jS9S-ePt_fTq3lquCh4aiuMDZmkZgGVzSljNq9yZjg33EjgYPiCMluZIssLWQpTCo60sJgVWjCN_ICcjblr7956DJ1a1cFg0-gWXR8UKxlkMmMCInr6B31xvW9jOxUN5VRQymWkzkdq-FzwWKm1r1fafyoKanCtomv17TqyJ5vEfhEt_ZI_ciNwOQIfdYOf_yepu9n1GPkFZV2Hvg</recordid><startdate>202408</startdate><enddate>202408</enddate><creator>Sweeny, Larissa</creator><creator>Long, Sallie M.</creator><creator>Pipkorn, Patrik</creator><creator>Wax, Mark K.</creator><creator>Thomas, Carissa M.</creator><creator>Curry, Joseph M.</creator><creator>Yang, Sara</creator><creator>Lander, Daniel</creator><creator>Chowdhury, Farshad</creator><creator>Amin, Dev</creator><creator>Kane, Anne C.</creator><creator>Miles, Brett A.</creator><creator>Salama, Andrew</creator><creator>Cannady, Steven B.</creator><creator>Tasche, Kendall</creator><creator>Mann, Derek</creator><creator>Jackson, Ryan</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4880-6172</orcidid><orcidid>https://orcid.org/0000-0003-0250-8636</orcidid></search><sort><creationdate>202408</creationdate><title>Microvascular reconstruction of medication related osteonecrosis of the head and neck</title><author>Sweeny, Larissa ; Long, Sallie M. ; Pipkorn, Patrik ; Wax, Mark K. ; Thomas, Carissa M. ; Curry, Joseph M. ; Yang, Sara ; Lander, Daniel ; Chowdhury, Farshad ; Amin, Dev ; Kane, Anne C. ; Miles, Brett A. ; Salama, Andrew ; Cannady, Steven B. ; Tasche, Kendall ; Mann, Derek ; Jackson, Ryan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3483-dfe043271cb0fd6122d6f62c33c3c7030c3b12dfc8568794c943e18de58a42ae3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antibiotics</topic><topic>Bisphosphonate-Associated Osteonecrosis of the Jaw - surgery</topic><topic>Complications</topic><topic>Female</topic><topic>free flap</topic><topic>Free Tissue Flaps</topic><topic>Head and neck</topic><topic>head and neck reconstruction</topic><topic>Humans</topic><topic>Jaw</topic><topic>Male</topic><topic>Maxilla</topic><topic>medication related osteonecrosis</topic><topic>Microvasculature</topic><topic>Middle Aged</topic><topic>Necrosis</topic><topic>Osteonecrosis</topic><topic>outcomes</topic><topic>Plastic Surgery Procedures - adverse effects</topic><topic>Plastic Surgery Procedures - methods</topic><topic>Postoperative</topic><topic>Retrospective Studies</topic><topic>Survival</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sweeny, Larissa</creatorcontrib><creatorcontrib>Long, Sallie M.</creatorcontrib><creatorcontrib>Pipkorn, Patrik</creatorcontrib><creatorcontrib>Wax, Mark K.</creatorcontrib><creatorcontrib>Thomas, Carissa M.</creatorcontrib><creatorcontrib>Curry, Joseph M.</creatorcontrib><creatorcontrib>Yang, Sara</creatorcontrib><creatorcontrib>Lander, Daniel</creatorcontrib><creatorcontrib>Chowdhury, Farshad</creatorcontrib><creatorcontrib>Amin, Dev</creatorcontrib><creatorcontrib>Kane, Anne C.</creatorcontrib><creatorcontrib>Miles, Brett A.</creatorcontrib><creatorcontrib>Salama, Andrew</creatorcontrib><creatorcontrib>Cannady, Steven B.</creatorcontrib><creatorcontrib>Tasche, Kendall</creatorcontrib><creatorcontrib>Mann, Derek</creatorcontrib><creatorcontrib>Jackson, Ryan</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Head & neck</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sweeny, Larissa</au><au>Long, Sallie M.</au><au>Pipkorn, Patrik</au><au>Wax, Mark K.</au><au>Thomas, Carissa M.</au><au>Curry, Joseph M.</au><au>Yang, Sara</au><au>Lander, Daniel</au><au>Chowdhury, Farshad</au><au>Amin, Dev</au><au>Kane, Anne C.</au><au>Miles, Brett A.</au><au>Salama, Andrew</au><au>Cannady, Steven B.</au><au>Tasche, Kendall</au><au>Mann, Derek</au><au>Jackson, Ryan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Microvascular reconstruction of medication related osteonecrosis of the head and neck</atitle><jtitle>Head & neck</jtitle><addtitle>Head Neck</addtitle><date>2024-08</date><risdate>2024</risdate><volume>46</volume><issue>8</issue><spage>1902</spage><epage>1912</epage><pages>1902-1912</pages><issn>1043-3074</issn><issn>1097-0347</issn><eissn>1097-0347</eissn><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.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>38294050</pmid><doi>10.1002/hed.27653</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-4880-6172</orcidid><orcidid>https://orcid.org/0000-0003-0250-8636</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult Aged Aged, 80 and over Antibiotics Bisphosphonate-Associated Osteonecrosis of the Jaw - surgery Complications Female free flap Free Tissue Flaps Head and neck head and neck reconstruction Humans Jaw Male Maxilla medication related osteonecrosis Microvasculature Middle Aged Necrosis Osteonecrosis outcomes Plastic Surgery Procedures - adverse effects Plastic Surgery Procedures - methods Postoperative Retrospective Studies Survival Treatment Outcome |
| title | Microvascular reconstruction of medication related osteonecrosis of the head and neck |
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