Risk Factors for Infection Recurrence After Surgical Resection of Advanced Stage Osteonecrosis of the Mandible.

Autor:	Doub JB; The Doub Laboratory of Translational Bacterial Research, University of Maryland School of Medicine, Baltimore, MD; Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD. Electronic address: Jdoub@ihv.umaryland.edu., Kang A; University of Maryland School of Medicine, Baltimore, MD., Lee C; Department of Oral-Maxillofacial Surgery, University of Maryland, Baltimore, MD., Dyalram D; Department of Oral-Maxillofacial Surgery, University of Maryland Schools of Dentistry and Medicine, Baltimore, MD., Shih P; Department of Anatomic Pathology, University of Maryland School of Medicine, Baltimore, MD., Twaddell WS; Department of Anatomic Pathology, University of Maryland School of Medicine, Baltimore, MD., Lubek JE; Department of Oral-Maxillofacial Surgery, University of Maryland Schools of Dentistry and Medicine, Baltimore, MD.
Jazyk:	angličtina
Zdroj:	Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons [J Oral Maxillofac Surg] 2024 Mar; Vol. 82 (3), pp. 332-340. Date of Electronic Publication: 2024 Jan 04.
DOI:	10.1016/j.joms.2024.01.001
Abstrakt:	Background: Advanced stage osteoradionecrosis (ORN) and medication-related osteonecrosis of the jaw (MRONJ) are challenging disease entities requiring multimodal therapy including surgical resection. However, risk factors associated with infection recurrence are poorly understood. Purpose: The purpose of this study was to identify risk factors associated with infection recurrence following resection of advanced stage ORN or MRONJ of the mandible. Study Design, Setting, Sample: This was a retrospective cohort study including patients who underwent segmental mandibulectomy for management of ORN or MRONJ between 2016 and 2021 at the authors' institution. Subjects who did not have margin viability data were excluded. Predictor/exposure/independent Variable: The primary predictor variable was viability of resection margins on histopathologic analysis (viable or nonviable). Secondarily, other risk factors categorized as demographic (age, sex, race), medical (comorbidities), and perioperative (reconstructive modality, antibiotic duration, microbiological growth) were evaluated. Main Outcome Variable: The primary outcome variable was time to infection recurrence defined as time from surgical resection to clinical diagnosis of a fistula tract, abscess, or persistent inflammatory symptoms necessitating surgical intervention. Covariates: Not applicable. Analyses: Descriptive and bivariate statistics were used to identify associations between risk factors and time to infection recurrence. A significance level of P ≤ .05 was considered significant. Results: The cohort consisted of 57 subjects with a mean age of 63.3 ± 10.0 years (71.9% Male, 75.4% White) treated for ORN (47.4%) or MRONJ (52.6%). A total of 19/57 (33%) subjects developed a recurrence of infection with 1 and 2 year survival of 75.8 and 66.2%, respectively. Nonviable resection margins were associated with earlier time to infection recurrence (P ≤ .001, hazard ratio (HR) = 11.9, 95% confidence interval (CI) = 3.84 to 36.7) as was younger age (P = .005, HR = 0.921, 95% CI = 0.869 to 0.976) and atypical pathogen growth on culture (P = .002, HR = 8.58, 95% CI = 2.24 to 32.8). Conclusions and Relevance: Histopathologic margin viability was associated with earlier time to infection recurrence following resection of advanced stage ORN or MRONJ of the mandible. Additional studies are needed to identify interventions that may improve outcomes in this demographic. (Copyright © 2024 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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