Author(s)
Peter Giannaris, BS
Hannah Bukzin
Joseph Masselli, DDS, MS
Mark Chaskes, MD
Charles Tong, MD, FARS
Judd Fastenberg, MD
Affiliation(s)
Northwell Health
Abstract:
Introduction: Management of Stage 3 maxillary MRONJ is often complicated by coexisting sinusitis. Oral sequestrectomy alone has historically shown high failure rates, likely due to unaddressed sinusitis. This study evaluates the efficacy of combined sequestrectomy and functional endoscopic sinus surgery (FESS) to promote faster mucosal healing and sinonasal symptom resolution.
Methods: A retrospective cohort study was conducted on 28 patients treated for Stage 3 maxillary MRONJ. All patients underwent sequestrectomy with FESS. Radiographic phenotypes were analyzed to assess recovery impact.
Results: There were 28 patients with stage 3 MRONJ. The mean age was 69.2 years, and most patients had metastatic malignancies (n=17,61%) including breast cancer, prostate cancer, and multiple myeloma. Among patients with available medication history, 75% were treated with high-potency antiresorptives, specifically Zoledronic Acid (n=6,37.5%) or Denosumab (n=6,37.5%). Surgical management included maxillary antrostomy (n=15,54%) and total ethmoidectomy (n=15,54%). Complete outcome data was available for 12 patients. The combined approach achieved a mucosal healing rate of 75.0% (9/12). The median time to healing was 2.6 months. Additionally, 80% (8/10) patients with reported data demonstrated complete resolution of chronic sinusitis symptoms. Notably, patients with sclerotic lesions demonstrated a robust 70% healing rate (7/10).
Conclusion: The addition of FESS to sequestrectomy in this setting effectively manages associated sinusitis and may contribute to improved surgical success and healing. The approach appears particularly effective for metastatic cancer patients on high-potency antiresorptives, regardless of radiographic phenotype.