Abstract
BackgroundBisphosphonates are frequently used for osteoporosis. Medication-related osteonecrosis of the jaw, a complication of bone-modifying agents, including bisphosphonates or angiogenic inhibitors, can be challenging to treat in elderly patients with numerous preexisting conditions. Achieving good treatment outcomes is especially difficult in patients with pathological fractures accompanied with extraoral fistulae.Case presentationWe report an unusual case of prominent bone regeneration following palliative surgical treatment in a 72-year-old Japanese female patient undergoing hemodialysis. She previously had severe osteoporosis due to renal osteodystrophy and was receiving antiresorptive intravenous bisphosphonate. Computed tomography revealed a discontinuous left lower mandibular margin with a pathologic fracture and extensive, morphologically irregular sequestrum formation (80 × 35 × 20 mm). The patient was diagnosed with stage III medication-related osteonecrosis of the jaw and pathologic mandibular fracture. Immediately before the surgery, the anticoagulant used for dialysis was changed from heparin to nafamostat mesylate to reduce the risk of intraoperative bleeding. Sequestrectomy was performed under general anesthesia. Postoperative infection was not observed, the intraoral and submandibular fistula disappeared, and, surprisingly, prominent spontaneous bone regeneration was observed postoperatively at 6 months. Despite the severe systemic condition of the patient, the conservative surgical approach with sequestrectomy has yielded desirable results for more than 6 years since the surgery.ConclusionsThis rare report of spontaneous bone regeneration in a patient of advanced age and poor general condition is the oldest case of mandibular regeneration ever reported.
Highlights
This rare report of spontaneous bone regeneration in a patient of advanced age and poor general condition is the oldest case of mandibular regeneration ever reported
The American Association of Oral and Maxillofacial Surgeons (AAOMS) recommends a combination of antibacterial mouth rinse, antibiotic therapy, and analgesics and/or surgical debridement/resection for stage III Medicationrelated osteonecrosis of the jaw (MRONJ) patients [2]
Two years before the referral, the patient developed fractures of the second, third, and fourth metatarsals on the left side, which revealed that she had severe chronic kidney disease–mineral and bone disorder (CKD-MBD) [6] with a young adult mean (YAM) value of 45%
Summary
Despite the severe systemic condition of this patient, the conservative surgical approach of sequestrectomy has yielded desirable results for more than 6 years to date.
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