Abstract
Background: Medication-related osteonecrosis of the jaw (MRONJ) may manifest as exposed mandible bone. Recent reviews of the incidence of MRONJ report primarily as exposed cortical bone of the mandibular body, ramus, and symphysis with no reports of condylar involvement. Objective: The aim of this study is to analyze the topographical incidence of MRONJ, comorbidities, demographics data, and clinical characteristics of patients diagnosed with MRONJ between 2014 and 2019 in the Maxillo-Facial Surgery Department University of Campania “Luigi Vanvitelli”, and compare these results with published reports. Methods: Data on 179 patients were collected for the study, including gender, age, underlying malignancy, medical history, and specific lesion location-identifying premaxilla and posterior sectors area involvement for the maxilla and symphysis, body, ramus, and condyle area for the mandible. A literature review was performed in order to compare our results with similar or higher sample sizes and find if any condylar involvement was ever reported. The research was carried out on PubMed database identifying articles from January 2003 to November 2020, where MRONJ site distribution was discussed, and data were examined to scan for condylar localization reports. Results: 30 patients had maxillary MRONJ, 136 patients had mandibular MRONJ, and 13 patients had lesions located in both maxilla and mandible. None of the patients reported condylar involvement, neither as a single site nor as an additional localization. Literature review results were coherent to our findings showing no mention of condylar MRONJ. Conclusion: Results do not show reports of condylar involvement in MRONJ. Although the pathophysiology of the disease has not been fully elucidated, two possible explanations were developed: the first one based on the condyle embryogenetic origin; the second one based on the bisphosphonate and anti-resorptive medications effects on the different vascular patterns of the mandible areas.
Highlights
Medication-Related Osteonecrosis of the Jaw (MRONJ) is a rare but severe condition characterized by non-healing exposed bone in patients that were or are currently using an antiresorptive or antiangiogenic drug and have no history of the previous radiotherapy to the head and neck area
30 patients had maxillary Medication-related osteonecrosis of the jaw (MRONJ), 136 patients had mandibular MRONJ, and 13 patients had lesions located in both maxilla and mandible
Literature review results were coherent to our findings showing no mention of condylar MRONJ
Summary
Medication-Related Osteonecrosis of the Jaw (MRONJ) is a rare but severe condition characterized by non-healing exposed bone in patients that were or are currently using an antiresorptive or antiangiogenic drug and have no history of the previous radiotherapy to the head and neck area. MRONJ surgical management should be performed through digital planning and using less invasive instruments, such as piezoelectric surgery and low-level laser therapy, which are described to minimize structural and vascular damage to the bone and promote a faster recovery of both soft and hard tissues [4 - 7]. These guidelines focus on the clinical and pathological features of MRONJ and represent the current standard staging and treatment. Recent reviews of the incidence of MRONJ report primarily as exposed cortical bone of the mandibular body, ramus, and symphysis with no reports of condylar involvement
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