Treatment of pathologic fractures of the mandible in stage III medication-related osteonecrosis of the jaw—an observational study

Spontaneous Recovery of Pathological Fracture Caused by Medication-Related Osteonecrosis of the Jaw

Pathological fracture is one of the most serious complications in medication-related osteonecrosis of the jaw (MRONJ). This case is a report of an 87-year-old woman who had been diagnosed with pathological fracture due to MRONJ. The authors performed minimally invasive and conservative treatment, such as intraoral dressing, antibiotic therapy, and simple debridement, for patients with pathologic fractures due to MRONJ. After 1 year, the inflammatory symptoms disappeared and pathological fractures spontaneously recovered.

Delayed Presentation of Mandibular Osteonecrosis Following Herpes Zoster Infection - A Case Report

Rationale

Apart from the usual presentation of herpes zoster (HZ) infection (HZI), reports of spontaneous teeth exfoliation and osteonecrosis are infrequent and sporadic.

Patient Concerns

A 51-year-old male patient presented with spontaneous exfoliation of multiple teeth and subsequent pathological fracture on the right side of the lower jaw after three months of HZI.

Diagnosis

Biopsy was taken from the alveolar bone of the oedematous region, which revealed the presence of trabeculae of dead bone with empty lacunae.

Intervention

Necrosed part of the alveolar bone was excised under local anaesthesia and antibiotic coverage, which was followed by open reduction and internal fixation of the pathological fracture under general anaesthesia.

Outcomes

The patient was followed up for one year without any evidence of recurrences.

Take-away Lessons

Presentation of osteonecrosis following HZI is unique but rare and should be diagnosed at the earliest.

Retrospective evaluation of pathologic fractures in medication related osteonecrosis of the jaw

The aim of this study was to focus on the MRONJ-related pathologic fractures, their incidence, and to analyze possible causative factors for their occurrence. Pathologic fracture in patients suffering frm MRONJ were identified, examined in detail, and the patient characteristics were evaluated. In 116 patients (73 female and 43 male; mean age 62.08 ± 13.6 years), pathologic fracture incidence was found to be 4.31%. Zoledronic acid was the most commonly used anti-resorptive drug (77.8%). Median antiresorptive usage was 24 months. Five patients had pathologic fractures in the mandible. Four fracture patients had metastatic prostate cancer, and one had metastatic renal cell cancer. This case series study can provide clinical insight into which factors are associated with pathologic fractures. Cancer type, medical comorbidities, additive toxicity of the combination of antiresorptive and antiangiogenic drugs, specific pathogens, and dento-alveolar surgical procedures may be some of the important factors that need to be considered. Since MRONJ-related pathologic fracture management can be complicated, it may be good to focus on the causative factors and prevent occurrence with regular follow-up as often as possible in line with these factors.