Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 Jan 5;13(1):e224455.
doi: 10.1136/bcr-2018-224455.

Medication-related osteonecrosis (MRONJ) of the mandible and maxilla

Louise Dunphy  1 , Giovanni Salzano  2 , Barbara Gerber  2 , Jennifer Graystone  2
Affiliations
Case Reports

Medication-related osteonecrosis (MRONJ) of the mandible and maxilla

Louise Dunphy et al. BMJ Case Rep. .

Corrected and republished in

Abstract

In 2003, Marx reported the first case of osteonecrosis of the jaw in 36 cases related to zoledronic acid or pamidronate. Painful bone exposure in the mandible or maxilla unresponsive to medical or surgical management was observed. In 2014, the American Association of Oral and Maxillofacial Surgeons proposed the term 'medication-related osteonecrosis of the jaw' (MRONJ). However, a non-exposed variant may also occur. MRONJ can lead to debilitating clinical sequelae with limited treatment options. We present the case of a 73-year-old woman with metastatic breast cancer and MRONJ of her mandible and maxilla following treatment with intravenous zoledronic acid and denosumab. Six months following dental extractions, she was referred to the Department of Oral and Maxillofacial Surgery for assessment of extensive necrosis of her maxilla and mandible. Extraoral draining sinuses were observed. A CT mandible showed cortical destruction with an ill-defined mixed sclerotic-lucent pattern in keeping with osteonecrosis. Due to her metastatic breast cancer, the extent of her necrosis and poor performance status, free flap reconstruction of her mandible was ruled out. She was treated conservatively.

Keywords: dentistry and oral medicine; unwanted effects / adverse reactions.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Discharging sinuses in the submental region. Clinical examination showed evidence of exposed bone in the maxilla and mandible.
Figure 2
Figure 2
A sequestrum was evident in the left mandible.
Figure 3
Figure 3
CT mandible showed cortical destruction with an ill-defined mixed sclerotic–lucent pattern in keeping with osteonecrosis.
See this image and copyright information in PMC

References

    1. Aghaloo TL, Felsenfeld AL, Tetradis S. Osteonecrosis of the jaw in a patient on denosumab. J Oral Maxillofac Surg 2010;68:959–63. 10.1016/j.joms.2009.10.010 - DOI - PMC - PubMed
    1. Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 2003;61:1115–7. 10.1016/S0278-2391(03)00720-1 - DOI - PubMed
    1. Migliorati CA. Bisphosphonates and oral cavity avascular bone necrosis. J Clin Oncol 2003;22:4253–4. - PubMed
    1. Ruggiero SL, Dodson TB, Fantasia J, et al. . American association of oral and maxillofacial surgeons position paper on medication-related osteonecrosis of the jaw—2009 update. J Oral Maxillofac Surg 2009;67. - PubMed
    1. WX Q, Tang LN, An H, et al. . Risk of osteonecrosis of the jaw in cancer patients receiving denosumab: a meta-analysis of seven randomised controlled trials. Int J Clin Oncol 2014;19. - PubMed

Publication types

MeSH terms

Substances