[Application of the submandibular gland for management of stage 3 medication-related osteonecrosis of the mandible].

Objective: To summarize the clinical outcomes of reconstruction plate fixation combined with submandibular gland translocation (A) or reconstruction plate fixation combined with submental island flap and submandibular gland (B) for mandibular stage-3 medication-related osteonecrosis of the jaw (MRONJ). Methods: The clinical data of the patients with stage-3 mandibular MRONJ treated with one of the above mentioned procedures from September 2014 to December 2020 in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, were retrospectively reviewed. The clinical data included the general data of the patients, the initial mucosal healing rate at the time of 2 weeks postoperatively and follow-up, and the occurrence of complications. Results: A total of 40 patients were treated, including 17 males and 23 females, aged (64.6±8.9) years. Among the patients, 33 were treated with operation A and 7 with operation B. The initial mucosal healing rate was 90% (36/40). Plate fracture occurred in 4 patients. The mean length of the mandibular bony defect was (4.5±1.4) cm (ranged from 2.1 to 8.0 cm). Conclusions: For management of stage-3 mandibular MRONJ, reconstruction plate fixation combined with submandibular gland translocation or with submental island flap and submandibular gland might be one of the effective and reliable options.目的： 总结重建钛板联合下颌下腺转位或重建钛板联合颏下岛状瓣嵌合下颌下腺治疗下颌骨3期药物相关性颌骨坏死（medication-related osteonecrosis of the jaw，MRONJ）的临床治疗效果。 方法： 纳入2014年9月至2020年12月于北京大学口腔医学院·口腔医院口腔颌面外科行手术治疗的下颌骨3期MRONJ患者。患者采用重建钛板联合下颌下腺转位治疗，组织缺损范围较大者需联合颏下岛状瓣嵌合下颌下腺，回顾性分析患者的临床资料，包括患者年龄、性别、术后2周和复查时口内外切口是否愈合，以及并发症（钛板折断）的发生情况，并计算患者的黏膜初期愈合率（术后2周，黏膜愈合的病例数÷总病例数×100%）。 结果： 本研究共纳入40例患者，男性17例，女性23例，年龄（64.6±8.9）岁；其中重建钛板联合下颌下腺转位患者33例，重建钛板联合颏下岛状瓣嵌合下颌下腺患者7例。患者骨缺损长度为（4.5±1.4） cm（2.1~8.0 cm），术后随访3个月至6年，90%（36/40）的患者黏膜初期愈合，10%（4/40）的患者出现钛板折断。 结论： 对3期下颌骨MRONJ患者，重建钛板联合下颌下腺转位或重建钛板联合颏下岛状瓣嵌合下颌下腺治疗的效果可靠。.