RESUMO
Introduction: Medication-related osteonecrosis of the jaw (MRONJ) poses a significant challenge considering the absence of a "gold standard" treatment. Cell-based therapy and tissue engineering offer promising therapeutic alternatives. This study aimed to harness the regenerative properties of adipose-tissue stromal vascular fraction (AT-SVF) and leukocyte-platelet-rich fibrin (L-PRF) for MRONJ treatment. AT-SVF contains mesenchymal stromal cells (MSC) and endothelial progenitor cells (EPC), which promote bone formation, while the L-PRF scaffold can serve as a three-dimensional scaffold for the AT-SVF and support tissue healing through growth factor release. Materials and methods: The protocol involved applying autologous AT-SVF within an L-PRF matrix following surgical debridement. Age, gender, body mass index, comorbidities, underlying oncological condition, prescribed antiresorptive treatment: BP or DMB, antiresorptive treatment duration, antiresorptive treatment potential discontinuation, number of MRONJ lesion, MRONJ location, MRONJ stage, MRONJ trigger factor were assessed for each patient. Patients underwent the procedure and were monitored for a minimum of 6 months based on clinical, biological and medical imaging criteria. Results: Nine patients, with a total of ten MRONJ lesions, participated in the study. Six patients were female, and three were male, with a mean age of 68 ± 8 years. Four patients had multiple myeloma (MM), three had metastatic breast cancer, and two had metastatic prostate cancer. Seven MRONJ cases were classified as stage II, and three were classified as stage III. Soft tissue completely healed within a month after treatment in nine cases, with no clinical improvement observed in the remaining case. During follow-up, no sign of MRONJ recurrence was observed. Tridimensional medical imaging revealed bone healing 6 months after the surgical procedure. Immunophenotyping confirmed the presence of MSC and EPC in the AT-SVF: 12,6 ± 4,5% CD31+, 20.5 ± 7,8% CD34+, 34,4 ± 7,3% CD146+ and 54,6 ± 7,4% CD45+. Conclusion: This prospective study introduces a potential new treatment approach for MRONJ using autologous AT-SVF within an L-PRF scaffold. Our results are encouraging and suggest the need for further investigation with a larger patient cohort to better understand the underlying mechanisms.
RESUMO
Fractures of the coronoid process are the rarest mandibular fractures and are mostly associated with other maxillofacial fractures. They are most often encountered in trauma. The CT-scanner is the gold standard for locating and characterizing this lesion. Although the diagnosis is made radiologically, clinical examination may reveal various symptoms specific to this fracture, which may appear frustrated when other facial fractures are associated. In most cases, conservative treatment by intermaxillary fixation is preferred. However, in specific cases, surgical intervention such as coronoidectomy or open reduction with osteosynthesis is indicated. The type of fracture, its location, the delay before its management, the clinic and the presence of associated fractures guide the therapeutic attitude. Surgical management must be followed by early and intensive physiotherapy to avoid zygomatico-coronoid ankylosis, the main complication of this fracture.
Les fractures de l'apophyse coronoïde sont les fractures mandibulaires les plus rares et majoritairement associées à d'autres fractures maxillo-faciales. Elles se rencontrent le plus souvent lors de traumatisme. Le CT-scanner est le gold standard pour localiser et caractériser cette lésion. Bien que le diagnostic soit radiologique, l'examen clinique peut révéler différents symptômes propres à cette fracture et qui peuvent paraître frustres lorsque d'autres fractures du massif facial y sont associées. Dans la majorité des cas, le traitement conservateur par fixation intermaxillaire est privilégié. Mais dans des indications précises, une intervention chirurgicale, comme une coronoïdectomie ou une réduction ouverte avec ostéosynthèse, est indiquée. Le type de fracture, sa localisation, le délai avant sa prise en charge, la clinique et la présence de fractures associées guident l'attitude thérapeutique. Une prise en charge chirurgicale doit être suivie de physiothérapie précoce et intensive pour éviter l'ankylose zygomatico-coronoïde, principale complication de cette fracture.
