Vascularised periosteal free flap reconstruction for medication-related osteonecrosis of the jaw: a case series

Abstract

**Introduction:** The standard of care for medication-related osteonecrosis of the jaw (MRONJ) involves antibiotics and local debridement to promote tissue healing over exposed bone. We compare outcomes for patients with advanced MRONJ managed with vascularised periosteal radial forearm free flap (RFFF) versus local nasolabial flap and conservative dental measures. **Methods:** A retrospective case series of patients presenting to the Alfred Hospital for evaluation and management of stage II or above MRONJ between 1 January 2014 and 30 June 2018. The hospital database was searched and a medical record review performed. Results of pre- and post-treatment imaging were analysed by a single senior radiologist blinded to treatment modality. Asymptomatic wound closure, radiological evidence of disease cessation and patient satisfaction at six months post-treatment according to treatment type were assessed. **Results:** Of the ten patients included in the study, four received dental measures, three received local nasolabial flap and three received RFFF flap. All flap reconstruction (6/6) showed asymptomatic wound closure and patient satisfaction at six months follow-up compared to patients managed with dental measures (1/4). All RFFF patients (3/3) showed increased bone deposition radiologically at six months compared to the dental group who showed a mixed (3/4) picture or worsened (1/4) picture. Nasolabial flap patients showed a mixed (2/3) or improved radiological picture (1/3). **Conclusion:** MRONJ is a relapsing disease. Preliminary evidence suggests that radical debridement with local nasolabial flap or RFFF reconstruction for advanced MRONJ is more effective at halting the disease and alleviating morbidity than conservative dental measures alone.