Denosumab Related Osteonecrosis of the Jaw with Spontaneous Necrosis of the Soft Palate: Report of a Life Threatening Case

doi:10.1155/2016/5070187

. 2016:2016:5070187.

doi: 10.1155/2016/5070187. Epub 2016 Aug 28.

Denosumab Related Osteonecrosis of the Jaw with Spontaneous Necrosis of the Soft Palate: Report of a Life Threatening Case

Mohammed Qaisi¹, Jamie Hargett², Matthew Loeb³, Jeffrey Brown⁴, Ronald Caloss⁵

Affiliations

¹ Oral-Head & Neck Oncology/Microvascular Surgery, Division of Oral & Maxillofacial Surgery and Division of Otolaryngology, John H. Stroger, Jr. Hospital of Cook County, 1900 W. Polk Street, Suite 612, Chicago, IL 60611, USA.
² University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
³ Advanced General Dentistry, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
⁴ Department of Oral & Maxillofacial Surgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
⁵ Department of Oral-Maxillofacial Surgery & Pathology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.

PMID: 27648313
PMCID: PMC5018314
DOI: 10.1155/2016/5070187

Denosumab Related Osteonecrosis of the Jaw with Spontaneous Necrosis of the Soft Palate: Report of a Life Threatening Case

Mohammed Qaisi et al. Case Rep Dent. 2016.

. 2016:2016:5070187.

doi: 10.1155/2016/5070187. Epub 2016 Aug 28.

Authors

Mohammed Qaisi¹, Jamie Hargett², Matthew Loeb³, Jeffrey Brown⁴, Ronald Caloss⁵

Affiliations

¹ Oral-Head & Neck Oncology/Microvascular Surgery, Division of Oral & Maxillofacial Surgery and Division of Otolaryngology, John H. Stroger, Jr. Hospital of Cook County, 1900 W. Polk Street, Suite 612, Chicago, IL 60611, USA.
² University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
³ Advanced General Dentistry, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
⁴ Department of Oral & Maxillofacial Surgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
⁵ Department of Oral-Maxillofacial Surgery & Pathology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.

PMID: 27648313
PMCID: PMC5018314
DOI: 10.1155/2016/5070187

Abstract

Bisphosphonates have been used for years in the treatment of patients with distant bony metastasis and in the prevention of osteoporosis. One of main side effects of these medications is the development of bisphosphonate related osteonecrosis of the jaw (BRONJ) in a small subset of patients. A new class of medications with a shorter half-life, known as receptor activator of nuclear factor kappa-B ligand (RANKL) inhibitors, was introduced with the hopes of avoiding this side effect. However, reports of osteonecrosis of the jaw after the use of RANKL inhibitors have also been documented. We report on a patient who developed a life threatening osteonecrosis of the jaw with sepsis shortly after switching from a bisphosphonate to a RANKL inhibitor for osteoporosis treatment. This patient developed several soft tissue defects including spontaneous necrosis of the soft palate. To our knowledge this is the first time this presentation has been described.

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Figures

**Figure 1**
Patient presents to the emergency room in November 2013 with left submandibular fistula.

**Figure 2**
Intraoral photographs of necrotic, exposed bone surrounding site of extracted tooth #20.

**Figure 3**
Intraoral photographs of soft tissue fistula in the right side of her soft palate.

**Figure 4**
Chest X-ray demonstrating findings suspicious of ARDS.

**Figure 5**
(a) CT scan shows no fluid collection or abscess. However, air is evident in the marrow on left side of the mandible. (b) CT scan showed air in the epidural space in cervical region.

**Figure 6**
(a) Soft tissue healing intraoral wounds 1 year after initiation of MRONJ. (b) Improved bony coverage. (c) Healed neck fistula.

See this image and copyright information in PMC

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References

1. Ruggiero S. L., Dodson T. B., Fantasia J., et al. American association of oral and maxillofacial surgeons position paper on medication-related osteonecrosis of the jaw—2014 update. Journal of Oral and Maxillofacial Surgery. 2014;72(10):1938–1956. doi: 10.1016/j.joms.2014.04.031. - DOI - PubMed
1. Salari Sharif P., Abdollahi M., Larijani B. Current, new and future treatments of osteoporosis. Rheumatology International. 2011;31(3):289–300. doi: 10.1007/s00296-010-1586-z. - DOI - PubMed
1. Allen M. R., Burr D. B. Bisphosphonate effects on bone turnover, microdamage, and mechanical properties: what we think we know and what we know that we don't know. Bone. 2011;49(1):56–65. doi: 10.1016/j.bone.2010.10.159. - DOI - PubMed
1. Hamadeh I. S., Ngwa B. A., Gong Y. Drug induced osteonecrosis of the jaw. Cancer Treatment Reviews. 2015;41(5):455–464. doi: 10.1016/j.ctrv.2015.04.007. - DOI - PubMed
1. Xu X.-L., Gou W.-L., Wang A.-Y., et al. Basic research and clinical applications of bisphosphonates in bone disease: what have we learned over the last 40 years? Journal of Translational Medicine. 2013;11, article 303 doi: 10.1186/1479-5876-11-303. - DOI - PMC - PubMed

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[1] Ruggiero S. L., Dodson T. B., Fantasia J., et al. American association of oral and maxillofacial surgeons position paper on medication-related osteonecrosis of the jaw—2014 update. Journal of Oral and Maxillofacial Surgery. 2014;72(10):1938–1956. doi: 10.1016/j.joms.2014.04.031. - DOI - PubMed

[2] Ruggiero S. L., Dodson T. B., Fantasia J., et al. American association of oral and maxillofacial surgeons position paper on medication-related osteonecrosis of the jaw—2014 update. Journal of Oral and Maxillofacial Surgery. 2014;72(10):1938–1956. doi: 10.1016/j.joms.2014.04.031. - DOI - PubMed

[3] Salari Sharif P., Abdollahi M., Larijani B. Current, new and future treatments of osteoporosis. Rheumatology International. 2011;31(3):289–300. doi: 10.1007/s00296-010-1586-z. - DOI - PubMed

[4] Salari Sharif P., Abdollahi M., Larijani B. Current, new and future treatments of osteoporosis. Rheumatology International. 2011;31(3):289–300. doi: 10.1007/s00296-010-1586-z. - DOI - PubMed

[5] Allen M. R., Burr D. B. Bisphosphonate effects on bone turnover, microdamage, and mechanical properties: what we think we know and what we know that we don't know. Bone. 2011;49(1):56–65. doi: 10.1016/j.bone.2010.10.159. - DOI - PubMed

[6] Allen M. R., Burr D. B. Bisphosphonate effects on bone turnover, microdamage, and mechanical properties: what we think we know and what we know that we don't know. Bone. 2011;49(1):56–65. doi: 10.1016/j.bone.2010.10.159. - DOI - PubMed

[7] Hamadeh I. S., Ngwa B. A., Gong Y. Drug induced osteonecrosis of the jaw. Cancer Treatment Reviews. 2015;41(5):455–464. doi: 10.1016/j.ctrv.2015.04.007. - DOI - PubMed

[8] Hamadeh I. S., Ngwa B. A., Gong Y. Drug induced osteonecrosis of the jaw. Cancer Treatment Reviews. 2015;41(5):455–464. doi: 10.1016/j.ctrv.2015.04.007. - DOI - PubMed

[9] Xu X.-L., Gou W.-L., Wang A.-Y., et al. Basic research and clinical applications of bisphosphonates in bone disease: what have we learned over the last 40 years? Journal of Translational Medicine. 2013;11, article 303 doi: 10.1186/1479-5876-11-303. - DOI - PMC - PubMed

[10] Xu X.-L., Gou W.-L., Wang A.-Y., et al. Basic research and clinical applications of bisphosphonates in bone disease: what have we learned over the last 40 years? Journal of Translational Medicine. 2013;11, article 303 doi: 10.1186/1479-5876-11-303. - DOI - PMC - PubMed

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Denosumab Related Osteonecrosis of the Jaw with Spontaneous Necrosis of the Soft Palate: Report of a Life Threatening Case

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Denosumab Related Osteonecrosis of the Jaw with Spontaneous Necrosis of the Soft Palate: Report of a Life Threatening Case

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