Nonoperative therapy in stage i mronj: is really an appropriate option?

Background. The best treatment option for early-stage le- sions in medication-related osteonecrosis of the jaw (MRONJ) remain controversial. Operative therapy (segmental or margin- al resection of the mandible and partial maxillectomy) are ef- fective methods to control MRONJ. The efficacy of nonopera- tive therapies in the management of MRONJ is documented in the literature. Nonoperative therapy include local wound care to exposed bone, antimicrobial rinses, removal of sequestrum, systemic antibiotics, pain control. The objective of our study was to compare the effects of operative versus nonoperative therapy on the resolution of stage 1 MRONJ. Patients and methods. We have carried out a retrospective analysis of patients with early lesions of MRONJ (stage 1 ac- cording to SIPMO-SICMF) treated at our department be- tween January 2020 and December 2022. Data collected and analyzed included: site of onj, treatment strategies, treatment success (defined as mucosal integrity without signs of infec- tion), worsening stage and necessity for surgical intervention over time. Results. A total of 74 patients were included in this study; a total of 20 (27.1%)) lesions were located in the maxilla and 54 (72.9%) lesions in the mandible. 43 (58,10%) patients re- ceived operative therapy; 31(41,9%) patients underwent non- operative therapy. The median follow-up period was 13.5 months in the surgical group compared with 12.5 months in the nonsurgical group. Treatment success was achieved in 10 patients in the nonoperative therapy group: of these, 6 showed worsening of disease stage and necessity for surgi- cal intervention during follow-up. Treatment success was achieved in all patients treated with surgery, with no recur- rence of disease during follow-up. Conclusions. The results of our report confirm that operative therapy represents the best treatment strategy even in stage I of MRONJ. Nonoperative strategies can be useful when signif- icant comorbidities preclude operative treatment.