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Osteonecrosis of Jaw: Common Etiologies, Uncommon Treatments

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Osteonecrosis of Jaw: Common Etiologies, Uncommon Treatments East Tennessee State University Digital Commons @ East Tennessee State University Appalachian Student Research Forum 2019 ASRF Schedule Apr 12th, 9:00 AM - 2:30 PM Osteonecrosis of Jaw: Common etiologies, uncommon treatments Utsab Panta Adam chan East Tennessee State University Debalina Das East Tennessee State University Follow this and additional works at: https://dc.etsu.edu/asrf Panta, Utsab; chan, Adam; and Das, Debalina, "Osteonecrosis of Jaw: Common etiologies, uncommon treatments" (2019). Appalachian Student Research Forum. 201. https://dc.etsu.edu/asrf/2019/schedule/201 This Oral Competitive is brought to you for free and open access by the Events at Digital Commons @ East Tennessee State University. It has been accepted for inclusion in Appalachian Student Research Forum by an authorized administrator of Digital Commons @ East Tennessee State University. For more information, please contact [email protected]. Osteonecrosis of Jaw: Common etiologies, uncommon treatments Utsab Raj Panta1, MD, Adam Chan1, Debalina Das1, MD, MPH 1East Tennessee State University, Department of Internal Medicine Introduction Case presentation continued Images Discussion continued First described in 2002, osteonecrosis of Later, patient complained of a piece of the jaw (ONJ, or avascular necrosis of the Case reports and series suggest benefit bone penetrating the skin of her chin and jaw) is an uncommon but potentially from hyperbaric oxygen therapy in wound presented with continuous drainage from serious side effect of treatment with healing, pain, and quality of life at three sinus tract in her mandible, which was bisphosphonates. Although months, however no significant diagnosed as osteonecrosis attributed to typically identified in patients with differences exist with outcomes beyond bisphosphonates, previous radiation multiple myeloma and other three months. Patients being considered therapy, and dental abscesses. malignancies, a few cases have been for therapy with a bisphosphonate should reported in patients taking be thoroughly evaluated for dental issues, bisphosphonates - a potent drug class Patient was started on abaloparatide, an prior to initiating therapy. Conservative used in the treatment of osteoclast- osteo-anabolic medication for management with limited debridement, mediated bone resorption issues, osteoporosis and enrolled in hyperbaric antibiotic therapy as needed, and topical including postmenopausal osteoporosis, oxygen therapy which immensely helped mouth rinses rather than aggressive Paget's disease, multiple myeloma, and in controlling sinus drainage. Patient is surgical resection are recommended. malignant hypercalcemia. The clinical currently awaiting mandibular Conservative therapy may result in diagnosis of ONJ can be obscured by reconstruction surgery. healing in a significant proportion of jaw pain, abscess, swelling, and fistulas, patients. Surgical resection of necrotic but exposed bone is a distinctive bone should be reserved for refractory or sign. This reports a case of ONJ advanced cases. secondary to bisphosphonate use in a Discussion 65-year-old woman and clinical management complications. Conclusion Case Presentation ONJ, often associated with pain, swelling, exposed bone, local infection, A 65-year-old lady with history of age- and pathologic fracture of the jaw, is a Providers should remain cautious while related osteoporosis and compression rare complication of bisphosphonate prescribing high doses of fractures on alendronate for 4 therapy. Currently, no prospective data bisphosphonates in patients with years, squamous cell carcinoma of neck exists to advise the benefits of therapy increased risk factors to prevent, timely status post excision and radiotherapy 11- discontinuation however most clinical diagnose and treat this condition. years prior, Sjogren's syndrome and practices tend to discontinue at least discoid lupus on hydroxychloroquine, temporarily. The incidence increases diabetes, hypertension, stroke and with longer treatment duration, References multiple dental abscesses presents with particularly when therapy exceeds four persistent neck pain. Initial CT neck with years. Risk factors for developing ONJ 1. Edwards BJ, Gounder M, McKoy JM, et al. Pharmacovigilance and reporting oversight in US contrast showed diffuse fat stranding. while taking bisphosphonates include IV FDA fast-track process: bisphosphonates and Subsequently, alendronate was administration, anticancer therapy, dose osteonecrosis of the jaw. Lancet Oncol 2008; discontinued due to jaw necrosis and duration of exposure, dental 9:1166. suspicion. Eight months later, repeat CT extractions/implants, glucocorticoids, 2. Khosla S, Burr D, Cauley J, et al. smoking, diabetes, and preexisting dental Bisphosphonate-associated osteonecrosis of the scan showed new non-mass-like soft jaw: report of a task force of the American tissue thickening in the subcutaneous fat disease. Society for Bone and Mineral Research. J Bone abutting the right anterior mandible Miner Res 2007; 22:1479. 3. Hoff AO, Toth BB, Altundag K, et al. Frequency with mandibular teeth cavities and Osteonecrosis of Right Mandible showing periapical lucencies, likely to be and risk factors associated with osteonecrosis of eroded bone and bone within bone formation the jaw in cancer patients treated with periodontal cellulitis secondary to bisphosphonate use and radiation intravenous bisphosphonates. J Bone Miner Res versus radiation osteonecrosis. treatment. 2008; 23:826..
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