For this study, the surgical outcomes of patients with advanced medication-related osteonecrosis of the jaw (MRONJ), treated with different local flaps for soft-tissue closure, were evaluated. Cases of stage 2 and 3 MRONJ patients (n = 96) with a 12-month minimum follow-up were retrospectively analyzed. All patients underwent surgical treatment and soft-tissue closure with local flaps, including buccal fat flap (BFF), nasolabial flap (NLF), facial artery musculomucosal flap (FAMM-F), and submental island flap (SIF), based on the size and location of the defects. The occurrence of side effects was also evaluated. At the time of the last follow-up, 97.7% (42 of 43) of the patients in the BFF group, 90.3% (28 of 31) of the NLF patients, 100% (8 of 8) of the FAMM-F patients, and 92.9% (13 of 14) of the SIF patients showed mucosal integrity. No serious complications were observed. Five cases with relapsed MRONJ were in cancer patients who continued both chemotherapy and antiresorptive therapy. Different local flaps for soft-tissue closure after bone surgery in advanced MRONJ patients could provide a mechanically stable and well-vascularized covering of the exposed bone, leading to good healing.
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