Juan M. Zárate’s thesis defends the efficacy of a new ultrasonic resective surgery protocol that shortens the disease – Salud Ediciones – Salud Ediciones

Juan Martín Zárate González The doctoral thesis «Efficacy of ultrasonic resective surgery in the management of drug-associated osteonecrosis of the jaws (mronj). Challenging old paradigms» Juan Martín Zárate González defends the efficacy of a new ultrasonic resective surgery protocol that shortens the duration of the disease Medication-associated osteonecrosis of the jaws (MRONJ) is a serious complication that destroys the bone of the jaws, generating infections recurrent, loss of teeth and, over time, can spread to other bones of the face, nose, skin or jaw. It mainly affects cancer patients with bone metastases from various tumors or multiple myeloma. In particular, it usually affects those who receive treatment with bone-sparing drugs (antiresorptives). In this population, drugs are very important, since they reduce the risk of pathological fractures. They also improve the prognosis in some tumors. On the other hand, although to a lesser extent, the disease can affect patients with osteoporosis. However, the treatment of the disease remains a subject of controversy and debate. The traditional paradigm and the current recommendations of the Spanish Society of Oral and Maxillofacial Surgery (SECOMCYC) maintain that the treatment of choice is conservative management (non-surgical), whose objective is the palliation of symptoms. Conservative surgery (bone scraping) is only indicated for refractory and advanced cases. With these recommendations, the disease becomes a chronic condition that requires prolonged suspension of antiresorptive treatment and that presents with frequent exacerbations. The patient suffers progressive loss of teeth, bone and serious affectation in the quality of life of patients. In this context, the doctoral thesis of Juan Martín Zárate González, defended at the UIB, gathers the results of the first research project of the Maxillofacial Surgery Service of the Son Espases Hospital. This project develops a protocol for ultrasonic resective surgery in patients. Started in 2018, it offers treatment to patients from diagnosis, regardless of the stage they are in, with the aim of completely curing and shortening the duration of the disease. The doctoral thesis collects and compares the results obtained in the Son Espases Maxillofacial Surgery Service in two consecutive periods, from 2010 to 2017, following the traditional paradigm and the recommendations of the SECOMCYC and from 2018 to 2021, based on the surgery protocol ultrasonic resective. The study shows how non-surgical conservative treatment is ineffective in terms of cure and is associated with high rates of clinical progression. The data that proves it is the following: 70% of the patients in the first cohort received non-surgical treatment. 70% of these ended up undergoing surgery due to disease progression. In addition, the research highlights that in this group, conservative surgery did not show better results than non-surgical treatment. On the other hand, the patients of the second cohort, operated with the resective surgery protocol, presented a cure rate of 94.1%, with a probability 186 times greater than with non-surgical treatment and 26 times more than with surgery. conservative. In this way, the thesis concludes that the new resective surgery protocol is more effective and safer than conservative surgery, since it has a lower complication rate and requires fewer interventions. The ultrasonic resective surgery protocol makes it possible to drastically shorten the duration of the disease. With the application of this protocol, reaching an average of two weeks. A much shorter period than the 19 months that the patients in the first cohort took. The thesis has received several awards, such as the award for the Best Doctoral Thesis Project 20212, awarded by the Mutual Medical Foundation and the COMIB. Also, the award for Outstanding Oral Communication, at the National Congress of Oral Surgery and Implementation of the SECOMCYC 2022. In addition, the Clinical Practice Guide for the diagnosis and treatment of osteonecrosis of the jaws associated with Son medications has been prepared. Spare. In short, thanks to this research it has been possible to standardize a work method and a highly effective treatment. And, at the same time, it has allowed the Son Espases Hospital Maxillofacial Surgery Service to be positioned as a pioneer and national and international reference center in the treatment of this serious disease that, in many parts of the world, is still considered chronic and incurable. . Readings: 119