Surgical treatment outcomes and prognostic factors in mandibular medication-related osteonecrosis of the jaw

Medication-related osteonecrosis of the jaw is a severe complication of anti-resorptive and anti-angiogenic therapies, with the mandible being particularly susceptible due to its limited vascularity. This retrospective study evaluated surgical outcomes and prognostic factors in 197 patients with advanced mandibular disease who underwent radical surgery (≥ 6-month follow-up). Surgical procedures included marginal resection with local mucoperiosteal flap closure, segmental resection with direct closure, and segmental resection with various reconstruction methods, including fibula free flap, reconstruction plate with submental island flap, or submandibular gland translocation. The overall success rate was 67.0%. Segmental resection demonstrated significantly higher success than marginal resection (78.6% vs 54.3%, P < 0.001). Among reconstruction methods, fibula free flap achieved the highest success rate at 93.8%. Multivariate analysis identified normal preoperative hemoglobin and serum calcium levels, and the presence of purulent discharge, as protective factors, while bilateral involvement and preoperative pain were associated with poorer outcomes. Although surgical outcomes improved over time with technical advances, success was constrained by patients’ compromised systemic conditions. This study confirms that tailored radical surgery, combined with complete lesion removal, appropriate reconstruction, and optimization of modifiable systemic factors, remains an effective strategy for advanced mandibular medication-related osteonecrosis of the jaw.