Unusual case of a conservatively treated pathological fracture after sequestrectomy in a patient with long-term oral bisphosphonate use

Kuijpers, Sophie C.C.; Roessel, Erik W. van; Merkesteyn, J.P.R. van

doi:10.1016/j.jcms.2010.03.022

Cited by 9 publications

(6 citation statements)

References 10 publications

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“…23,24 However, given that health-associated quality of life varies among individuals depending on their perceptions of their goals, standards, expectations, and concerns, 25 treatment options should be chosen on the basis of maintenance of oral function and pain control. 3,14 The present case is considered to have an acceptable outcome following minimally invasive treatments over 4 years. Abstract: Xeroderma pigmentosum (XP) is characterized by photohypersensitivity of sun-exposed tissues and several thousandfold increased risk of developing malignant neoplasms of the skin and eyes.…”

Section: Discussionmentioning

confidence: 97%

“Phoenix Jaw”-Bone Regeneration of the Necrotic Mandible Between Pathological Fractures

Imai¹,

Michizawa²

2014

Journal of Craniofacial Surgery

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Management of advanced bisphosphonate-related osteonecrosis of the jaw, particularly in cases of pathological fractures with extraoral fistulas, is a challenging responsibility for craniomaxillofacial specialists. Although a periosteal reaction is occasionally observed in cases with extensive sequestra, few reports have documented circumferential periosteal osseous formation resulting in bone repair. We present the case of a 78-year-old woman who was treated for breast cancer and received intravenous bisphosphonates. She had bisphosphonate-related osteonecrosis of the jaw with bilateral pathological fractures of the mandible. During the course of minimally invasive treatment, the necrotic segment was separated with circumferential exposure, and new bone spontaneously formed with osseous union to the unilateral fractured stump. The present case typically highlights the potential of periosteal osteogenesis to regain an acceptable state even for patients with severe "bis-phossy jaw," particularly those with pathological fractures, although we do not advocate the universality of the phenomenon presented as "phoenix jaw."

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Section: Discussionmentioning

confidence: 97%

“Phoenix Jaw”-Bone Regeneration of the Necrotic Mandible Between Pathological Fractures

Imai¹,

Michizawa²

2014

Journal of Craniofacial Surgery

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“…There are ≈24 reported cases of stage 3 MRONJ associated with oral BPs (Table 2), 5‐16 which is more prevalent in females 5‐13 . Most cases of oral BP–induced stage 3 MRONJ occur in the mandible 5‐12,14,16 .…”

Section: Introductionmentioning

confidence: 99%

“…Most cases of oral BP–induced stage 3 MRONJ occur in the mandible 5‐12,14,16 . The most common clinical feature is extraoral fistula, 5‐10,14 followed by fracture, 6,8‐11 osteolysis, 10,15 and oroantral communication 5 …”

Section: Introductionmentioning

confidence: 99%

“…4 Patients with stage 3 MRONJ present with pain, infection, and exposed necrotic bone extending beyond the alveolar bone region in combination with either a pathologic fracture, extraoral fistula, oroantral or oronasal communication, or osteolysis extending to the inferior border of the mandible or sinus floor. 4 There are z24 reported cases of stage 3 MRONJ associated with oral BPs (Table 2), [5][6][7][8][9][10][11][12][13][14][15][16] which is more prevalent in females. [5][6][7][8][9][10][11][12][13] Most cases of oral BP-induced stage 3 MRONJ occur in the mandible.…”

Section: Introductionmentioning

confidence: 99%

“…4 There are z24 reported cases of stage 3 MRONJ associated with oral BPs (Table 2), [5][6][7][8][9][10][11][12][13][14][15][16] which is more prevalent in females. [5][6][7][8][9][10][11][12][13] Most cases of oral BP-induced stage 3 MRONJ occur in the mandible. [5][6][7][8][9][10][11][12]14,16 The most common clinical feature is extraoral fistula, [5][6][7][8][9][10]14 followed by fracture, 6,[8][9][10][11] osteolysis, 10,15 and oroantral communication.…”

Section: Introductionmentioning

confidence: 99%

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Advanced Stage of Medication‐Related Osteonecrosis of the Jaw Associated With Oral Bisphosphonates: Report of Three Cases

Ojha

Cohen

Choi

et al. 2017

Clin Adv Periodontics

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Introduction: Bisphosphonates (BPs) are prescribed for treating diseases exhibiting high bone turnover rates. Medication‐related osteonecrosis of the jaw (MRONJ) is a major adverse effect of BPs. Cases of MRONJ associated with oral BPs for treatment of osteoporosis are much less common compared with intravenous BPs. Most reports of oral BP–associated MRONJ are either stage 1 or stage 2 as classified by the 2014 American Academy of Oral and Maxillofacial Surgeons position paper (Ruggiero et al., J Oral Maxillofac Surg 2014;72:1938‐1956). There are ≈24 reported cases of oral BP–induced stage 3 MRONJ presenting as an area of exposed necrotic bone with pain and infection along with a pathologic fracture, an extraoral fistula, oroantral communication, or osteolysis extending to the inferior border of the mandible or sinus floor. Case Series: Three cases of stage 3 MRONJ associated with oral BPs are presented. All three patients had a long history of use of alendronate for over 10 years. Diagnosis of stage 3 MRONJ was made based on clinical, radiographic, and histopathologic findings. Patients were managed with a course of antibiotics and removal of the necrotic bone. Conclusions: Development of stage 3 MRONJ associated with oral BPs is relatively rare. However, there is an increased risk of advanced MRONJ associated with oral BPs in the presence of longer duration of therapy, dentoalveolar surgery, denture trauma, inflammatory oral diseases, and presence of comorbid factors. Therefore, it is recommended that clinicians educate patients about the advanced adverse effects of oral BPs.

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A simple evaluation method for early detection of bisphosphonate-related osteonecrosis of the mandible using computed tomography

Hamada

Matsuo

Koizumi

et al. 2014

Journal of Cranio-Maxillofacial Surgery

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Unusual case of a conservatively treated pathological fracture after sequestrectomy in a patient with long-term oral bisphosphonate use

Cited by 9 publications

References 10 publications

“Phoenix Jaw”-Bone Regeneration of the Necrotic Mandible Between Pathological Fractures

“Phoenix Jaw”-Bone Regeneration of the Necrotic Mandible Between Pathological Fractures

Advanced Stage of Medication‐Related Osteonecrosis of the Jaw Associated With Oral Bisphosphonates: Report of Three Cases

A simple evaluation method for early detection of bisphosphonate-related osteonecrosis of the mandible using computed tomography

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