Abstract
After the first report of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in 2003, it has increased significantly since then. We report a very rare extensive case never seen before in our experience of bone exposure with necrosis reaching the mandibular inferior border. Although the treatment modalities are not yet established, most researchers have recommended conservative approaches. The surgery was to be as conservative as possible, with a resection of the mandibular range followed by reconstruction using titanium plate with space maintainer. The authors would like to share their approach, management, and awareness.
Highlights
After the first report of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in 2003 [1,2,3,4], the American Association of Oral and Maxillofacial Surgeons (AAOMS) defined BRONJ in their 2009 position paper as “necrotic bone exposure in the maxillofacial region lasting for more than 8 weeks in patients with previous or current administration of bisphosphonate (BP) and with no history of radiation therapy” [4,5]
We report a very rare extensive case never seen before in our experience of bone exposure with necrosis reaching the mandibular inferior border
The surgery was to be as conservative as possible, with a resection of the mandibular range followed by reconstruction using titanium plate with space maintainer
Summary
After the first report of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in 2003 [1,2,3,4], the American Association of Oral and Maxillofacial Surgeons (AAOMS) defined BRONJ in their 2009 position paper as “necrotic bone exposure in the maxillofacial region lasting for more than 8 weeks in patients with previous or current administration of bisphosphonate (BP) and with no history of radiation therapy” [4,5]. A 68-year-old patient was referred to us in emergency condition by a hematologist for restricted opening of the mouth with bone exposure and loss of eating pleasure. In his history, the patient was followed in clinical hematology for multiple myeloma treated with eight CTD cures (cyclophosphamide, thalidomide, dexamethasone) in addition to monthly zoledronate (Zometa®, Novartis Pharma Maroc group, Morocco) cures years ago. The periodical checks carried out show a relatively good state of health of the patient, without exposure of material (Figures 8-9)
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