Severe osteonecrosis of the jaw with attempted near total mandibular exfoliation

Abstract

This report describes an unusual and extreme case of osteonecrosis of the jaw (ONJ) affecting the entire mandible, which was attempting to self exfoliate. A 76‐year old male presented clinically with all aspects of the mandible, except the condylar heads, necrotic and exposed in the oral cavity. The mandible had elevated out of the mucosa and was attempting to exfoliate through the mouth. As it was obstructing his oral cavity, the necrotic mandible was sectioned posteriorly allowing the patient to speak and eat comfortably, as well regain an oral seal. The use of intravenous bisphosphonates for metastatic prostate cancer coupled glucocorticosteroids, diabetes mellitus and hyperlipidaemia are likely to have contributed this extensive medication related ONJ. This complication is well‐recognised in association with bisphosphonates, however, this case is unique due to its severity, its spontaneous occurrence and the oral cavity's natural response to manage it, through near complete self exfoliation.