Abstract
Patients exposed to a combination of antiresorptive medication and radiotherapy of the head and neck area developing necrosis of the jaw in the course of treatment are extremely rare. Therefore the aim of this study was to identify outcome and complications in this highly vulnerable patient cohort. Patients and Methods: Seventeen patients who received both, antiresorptive treatment and radiotherapy (MRONJ/ORN-Group) in the head and neck area were enrolled in this study. Included patients were treated in our department between 2005 and 2022. 424 patients with medication-related osteonecrosis of the jaw (MRONJ-Group) and 138 patients with osteoradionecrosis of the jaw were enrolled as two control groups (ORN-Group). Demographic data, lesion localisation, date of primary diagnosis, clinical symptoms, type of therapy (surgical or non-surgical), details on antiresorptive treatment, outcome, and complications were recorded. Results: Pathological fractures, continuity resection and recurrence appear more often in patients who receive a combination of antiresorptive treatment and radiotherapy in the head and neck area compared to patients undergoing only one of these treatments. There was a statistically significant difference (p<0.001) between MRONJ/ORN-Group and MRONJ-Group and MRONJ/ORN-Group and ORN-Group considering recurrence, fracture and continuity resection. Patients with ORN combined with MRONJ have a 4-times higher risk for developing recurrence compared to patients with MRONJ and a 1.5-times higher risk for recurrence compared to patients with ORN. Jaw fracture and continuity resection appear more often in patients with MRONJ/ORN. Conclusion: Patients under antiresorptive therapy in combination with radiation therapy in the head and neck area have a higher risk for developing complications in case of osteonecrosis of the jaws. Therefore, a strict follow-up care schedule is highly recommended.
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