Neurosensory Disturbances Related to the Inferior Alveolar Nerve Amongst Patients With Mandibular Medication-Related Osteonecrosis of the Jaw (MRONJ): A Clinical and Radiological Overview

INTRODUCTION AND AIMS: The aims of this study were to evaluate the clinical and radiological characteristics of patients diagnosed with mandibular medication-related osteonecrosis of the jaw (MRONJ) and to examine its associations with neurosensory disturbances (NSD) related to the inferior alveolar nerve. METHODS: A retrospective review was conducted of all patients diagnosed with MRONJ who had undergone cone-beam computed tomography (CBCT) or computed tomography (CT) imaging in the Department of Oral and Maxillofacial Surgery at the Prince Philip Dental Hospital between January 2013 and August 2024. Clinical characteristics and the radiological manifestations of the mandibular canal were extracted. Statistical analyses were carried out with the significance level set at 5%. RESULTS: A total of 61 patients with 65 MRONJ lesions were included, of which 21 lesions (32.3%) exhibited neurosensory disturbances. The most common radiological manifestation of the MC was osteosclerotic (60%) and osteolytic changes (60%), followed by sequestration (46.2%). Multivariate logistic regression analysis identified active infection (adjusted OR 4.91, 95% CI: 1.14-21.2, p = .033) and sequestrum impingement (adjusted OR: 6.17, 95% CI: 1.76-21.7, p = .005) as significant associations of NSD. Four out of 15 patients with active infection and preintervention NSD presented with complete resolution of NSD following the elimination of the infection. CONCLUSION: Approximately one-third of mandibular MRONJ lesions presented with NSD. Sequestration impinging on the MC and active infection are associated with the presence of NSD. CLINICAL RELEVANCE: The removal of sequestrum and treatment of infection may lead to an improvement in pre-intervention NSD; therefore, the inferior alveolar nerve should not be sacrificed routinely during the operation.