Impact of Surgical Treatment for Medication-related Osteonecrosis of the Maxilla on Outcome of Concomitant Maxillary Sinusitis

doi:10.13701/j.cnki.kqyxyj.2026.08.011

Abstract

Abstract: Objective: To evaluate the outcomes of concomitant maxillary sinusitis following surgical treatment for medication-related osteonecrosis of the maxilla. Methods: Clinical data of patients with maxillary medication-related osteonecrosis of the jaws (MRONJ) complicated by maxillary sinusitis who were treated in the First Ward of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital of Nanjing Medical University (Nanjing Stomatological Hospital) from January 2013 to August 2025 were collected. A total of 31 patients were enrolled. Their basic clinical characteristics, surgical procedures, tissue healing status, pain relief, and changes in maxillary sinus inflammation during follow-up were analyzed retrospectively. Results: Postoperatively, 30/31 patients (96.77%) achieved complete wound healing, and no complications including tissue necrosis, wound infection, or MRONJ recurrence were observed during follow-up. However, wound dehiscence occurred in 1 patient during follow-up. Regarding maxillary sinusitis: it resolved in 14/31 cases (45.16%), the inflammation grade decreased significantly in 13/31 cases (41.94%), and no improvement was noted in 4/31 cases (12.90%). Conclusion: The treatment protocol, which involves thorough sequestrectomy during surgery, preservation of residual maxillary sinus mucosa, sinus irrigation, effective closure of the oroantral communication, and perioperative antibiotic use, can significantly improve maxillary MRONJ and its concomitant maxillary sinusitis, thereby greatly enhancing patients' quality of life.

Key words: medication-related osteonecrosis of the jaws, maxillary sinusitis, maxillary sinus mucosa, buccal fat pad flap, antibiotics

XU Huixia, KOU Jiahao, HE Jinyuan, SUN Guowen. Impact of Surgical Treatment for Medication-related Osteonecrosis of the Maxilla on Outcome of Concomitant Maxillary Sinusitis[J]. Journal of Oral Science Research, 2026, 42(8): 702-707.

References

[1] Psillas G, Papaioannou D, Petsali S, et al. Odontogenic maxillary sinusitis: A comprehensive review [J]. J Dent Sci, 2021, 16(1):474-481.
[2] Kujanpää M, Vuollo V, Tiisanoja A, et al. Incidence of medication-related osteonecrosis of the jaw and associated antiresorptive drugs in adult finnish population [J]. Sci Rep, 2025, 15(1):17377.
[3] Ruan HJ, Chen H, Hou JS, et al. Chinese expert consensus on the diagnosis and clinical management of medication-related osteonecrosis of the jaw [J]. J Bone Oncol, 2024, 49:100650.
[4] Wasserzug O, Kaffe I, Lazarovici TS, et al. Involvement of the maxillary sinus in bisphosphonate-related osteonecrosis of the jaw: radiologic aspects [J]. Am J Rhinol Allergy, 2017, 31(1):36-39.
[5] Mast G, Otto S, Mücke T, et al. Incidence of maxillary sinusitis and oro-antral fistulae in bisphosphonate-related osteonecrosis of the jaw [J]. J Craniomaxillofac Surg, 2012, 40(7):568-571.
[6] 高娜,田美,孙亚威,等.骨管技术在Ⅱ期下颌骨药物相关性颌骨坏死手术中的应用初探[J].华西口腔医学杂志,2024,42(5):629-635.
[7] Yamagata K, Nagai H, Baba O, et al. A case of brain abscess caused by medication-related osteonecrosis of the jaw [J]. Case Rep Dent, 2016, 2016:7038618.
[8] Kurabayashi T, Ida M, Yoshino N, et al. Usefulness of CT images for diagnosis of odontogenic maxillary sinusitis [J]. Oral Radiol, 1995, 11(2):21-30.
[9] Otsuru M, Hayashida S, Morishita K, et al. Retrospective analysis of treatment outcomes of maxillary sinusitis associated with medication-related osteonecrosis of the jaw [J]. Int J Environ Res Public Health, 2022, 19(12):7430.
[10] Ruggiero SL, Dodson TB, Assael LA, et al. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws--2009 update [J]. J Oral Maxillofac Surg, 2009, 67(5 Suppl):2-12.
[11] Park JH, Alfafara AM, Park YL, et al. Medication-related osteonecrosis of the maxilla: Prognosis of oral surgery combined with endoscopic sinus surgery [J]. Oral Dis, 2021, 27(4):962-969.
[12] Maurer P, Sandulescu T, Kriwalsky MS, et al. Bisphosphonate-related osteonecrosis of the maxilla and sinusitis maxillaris [J]. Int J Oral Maxillofac Surg, 2011, 40(3):285-291.
[13] Yu Y, Dang RR, Fan W, et al. Maxillary sinus mucosa preservation versus mucosal sacrifice: radiographic outcomes after inferior maxillectomy and soft-tissue free flap reconstruction [J]. Head Neck, 2025, 47(3):956-961.
[14] Andersen SWM, Mogensen DG, Schioedt M, et al. Surgical treatment of 61 consecutive patients with maxillary stage 3 medication-related osteonecrosis of the jaws using a pedicled buccal fat pad [J]. Oral Maxillofac Surg, 2022, 27(2):251-261.
[15] Kang MH, Lee DK, Kim CW, et al. Clinical characteristics and recurrence-related factors of medication-related osteonecrosis of the jaw [J]. J Korean Assoc Oral Maxillofac Surg, 2018, 44(5):225-231.
[16] Jose A, Rawat A, Nagori SA, et al. Outcomes of sequestrectomy and buccal fat pad reconstruction in the management of medication-related osteonecrosis of the jaws [J]. Oral Maxillofac Surg, 2022, 26(1):147-153.
[17] Egyedi P. Utilization of the buccal fat pad for closure of oro-antral and/or oro-nasal communications [J]. J Maxillofac Surg, 1977, 5(4):241-244.
[18] Favero G, Van Noorden CJF, Rezzani R. The buccal fat pad: A unique human anatomical structure and rich and easily accessible source of mesenchymal stem cells for tissue repair [J]. Bioengineering (Basel), 2024, 11(10):968.
[19] Berrone M, Florindi FU, Carbone V, et al. Stage 3 medication-related osteonecrosis of the posterior maxilla: surgical treatment using a pedicled buccal fat pad flap: Case reports [J]. J Oral Maxillofac Surg, 2015, 73(11):2082-2086.
[20] 郭玉兴,赵宁,王佃灿,等.以带蒂颊脂垫为基础的双层软组织封闭技术修复药物相关颌骨坏死手术后上颌骨缺损的临床应用[J].华西口腔医学杂志,2022,40(1):61-67.
[21] Akashi M, Kusumoto J, Takeda D, et al. A literature review of perioperative antibiotic administration in surgery for medication-related osteonecrosis of the jaw [J]. Oral Maxillofac Surg, 2018, 22(4):369-378.
[22] Hershberger MW, He P, Francois K, et al. Is maxillary sinusitis and radiographic maxillary sinus opacification associated with an altered microbiology of MRONJ? [J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2024, 137(4):345-354.