Two cases of medication ‐related osteonecrosis of the jaw with extension to the cranial base

AbstractThere is no established treatment for medication ‐related osteonecrosis of the jaw (MRONJ). Advanced MRONJ of the maxilla dose not cure with conservative treatment, and progression may cause neurological symptoms. We herein report two cases in which MRONJ of the maxilla spread to the skull base despite conservative treatment, causing abducens pa ralysis in one case and hydrocephalus in the second.Case 1: A 50 ‐year‐old woman who received denosumab for 2 years for multiple bone metastases of breast cancer developed MRONJ in the left maxilla after tooth extraction. MRONJ of the maxillae can progress to the skull and may cause neurological symptoms. Abducens paralysis developed for MRONJ. Magnetic reson ance images revealed narrowing of the internal carotid artery and necrosis of the sphenoid bone and clivus. Sequestrectomy was performed. Two weeks after surgery, abducens paralysis resolved. Magnetic resonance imaging 3 months after surgery showed improvement of internal carotid artery narrowing.Case 2: A 73 ‐year‐old woman who received zoledronic acid for 2 years for multiple bone metastases of breast cancer developed MRONJ in the left maxilla that spread broadly despite conservative treatment. Sequestrectomy was planned, but the patient developed altered consciousness and a stiff neck; ventricular enlargement was observed on magnetic resonance images of the brain. We diagnosed hydrocephalus resulting from bacterial meningitis caused by MRONJ; ventricular drai...
Source: Oral Surgery - Category: ENT & OMF Authors: Tags: CASE REPORT Source Type: research