Annali di Stomatologia 2014; Suppl.2: 15
Frattura patologica mandibolare causata da osteonecrosi mascellare correlata all’uso di bisfosfonati (BRONJ)
Pathologic fracture of the mandible due to BRONJ
G. Ascani (1), P. Mancini (1), F. Di Cosimo (2), M. Costa (2)
(1) Department of Maxillofacial Surgery, Spirito Santo Hospital, Pescara, Italy
(2) Department of Otorhinolaryngology, Spirito Santo Hospital, Pescara, Italy
Up to now there are only limited data concernig incidence and management of
pathologic fracture of the mandible due to bisphosphonate-related osteonecro-
sis of the jaw.
We report a case of a 71 –year-old woman hospitalized in our Department with a diagnosis of left submandibular abscess and cutaneus fistula. Medical history of the patient revealed no major illnesses neither facial traumas neither recent dental treatments. The patient was taking Fosamax® (alendronate sodium) for the treatment of osteoporosis from 10 years, orally 70 mg a week. A CT-scan showed area of bone sequestration and pathological fracture of the mandible and a diagnosis of BRONJ stage III was made based on the criteria of the American Association of Oral and Maxillofacial Surgery (AAOMS, 2007).
The patient underwent surgical treatment, consisting in:
– extraoral-submandibular approach with excision of the fistula,
– sequestrotomy with removal of necrotic bone parts and fracture reduction,
– rigid internal fixation and mandibular reconstruction using a preformed reconstruction titanium plate.
The surgery was supported by intravenous antibiotic therapy for one week, followed by orally administration for two weeks. During the follow-up period (22 month) was observed a good healing without exposure of the reconstruction plate and acceptable functional and aesthetical results.
The pathological fracture represent the severest complication of BRONJ in the mandible, and seriously impairs the quality of life of the patient. Despite this, there are no therapy guidelines and surgical protocols are still controversial, ranging from conservative management up to radical bone resection with microvascular reconstruction. In our opinion, in the treatment of pathologic fractures of the mandible due to BRONJ, good functional and aesthetical results can be achieved removing the necrotic bone parts and performing a load-bearing osteosynthesis.
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Ascani G et al. Pathologic fracture of the mandible due to BRONJ. Ann Somatol 2014; 5 (suppl 2): 15