# Fat Graft in Surgical Treatment of Medication-Related Osteonecrosis of the Jaws (MRONJ)
## 3 Results  
The search retrieved a total of 21 treated patients: nine receiving sequestrectomy with autologous fat graft (group A) and 12 receiving sequestrectomy alone (group B). All included patients were operated by the same surgeon between 2007 and 2012. Thus, the retrieved data were based on the AAOMS guidelines in force at the time [27]. Group A was represented by three males and six females, in a range of age 45 and 75 years; three patients had multiple myeloma, three had breast cancer, two had prostate cancer, and one had lung cancer. The mandible was affected in seven cases, while the maxilla was affected in two. Pamidronic acid was administered in six patients, zoledronic acid was administered in two patients, and one patient received a combination therapy of both. The mean BMA therapy duration was 38 weeks. One patient was affected by diabetes, one was affected by cardiac disease, and one was affected by both. Four patients presented a stage 2 MRONJ, while the remaining five had a diagnosis of stage 3 MRONJ. Figure 3: After the fat is transferred to a 5 mL syringe, it is injected through the sutured mucosal margins of the surgical wound until the underlying space is filled. Group B was represented by four males and eight females, in a range of age 48 and 86 years; three patients had multiple myeloma, six had breast cancer, one had prostate cancer, and two had lung cancer. The mandible was affected in nine cases, while the maxilla was affected in two, and one patient had the involvement of both. Pamidronic acid was administered in seven patients, zoledronic acid was administered in three, while two patients received a combination therapy of both. The mean BMA therapy duration was 41 weeks. One patient was affected by diabetes, two were affected by cardiac disease, and one was affected by both. Six patients presented a stage 2 MRONJ, while the remaining six had a diagnosis of stage 3 MRONJ. Sociodemographic and disease-related data are summarized in Table 2.  
The disease evolved toward a complete resolution in seven patients in group A (Figures 4 and 5), and a complete mucosal healing was achieved; the disease remained stable in one patient, who developed the relapse of the bone exposure; one patient experienced a progression toward more severe conditions. Among patients in group B, three demonstrated a complete resolution of the disease, and a complete mucosal healing was achieved; the disease remained stable in three patients, who developed the relapse of the bone exposure; the remaining six experienced a progression toward more severe conditions. \begin{table}
\begin{tabular}{c c c} \hline  & **Group A** & **Group B** \\ \hline Cases (\(n\)) & 9 & 12 \\ Gender (\(n\)) & & \\ Male & 3 & 4 \\ Female & 6 & 8 \\ \hline Age (years) & & \\ Median & 58 & 60 \\ Range & 45–75 & 48–86 \\ Smoking (\(n\)) & 0 & 0 \\ \hline Reason for BMAs assumption (\(n\)) & & \\ Multiple myeloma & 3 & 3 \\ Breast cancer & 3 & 6 \\ Prostate cancer & 2 & 1 \\ Lung cancer & 1 & 2 \\ Osteoporosis & 0 & 0 \\ \hline MRONJ localization (\(n\)) & & \\ Mandible & 7 & 9 \\ Maxilla & 2 & 2 \\ Mandible and maxilla & 0 & 1 \\ \hline Assumed BMAs (\(n\)) & & \\ Zoledronate & 6 & 7 \\ Pamidronate & 2 & 3 \\ Zoledronate + Pamidronate & 1 & 2 \\ \hline Duration of administration (months) & & \\ Median value & 38 & 41 \\ Range & (4–65) & (3–90) \\ \hline Comorbidities (\(n\)) & & \\ Diabetes & 1 & 1 \\ Cardiopathy & 1 & 2 \\ Diabetes and cardiopulmonary & 1 & 1 \\ \hline Baseline MRONJ stage (\(n\)) & & \\ Stage 2 & 4 & 6 \\ Stage 3 & 5 & 6 \\ \hline \end{tabular}
\end{table} 
Table 2: Sociodemographic and disease-related variables. The univariate analysis showed that the type of intervention was significantly associated with the clinical course after surgery of the patient, with the improvement (77.8 vs. 22.2%; [PERSON]'s exact \(p=0.030\)) with no modification (11.1 vs. 25%; [PERSON]'s exact \(p=0.603\)) and with worsening (11.1 vs. 50%; [PERSON]'s exact \(p=0.159\)) (Table 3).