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Stomatologija 2015; 17 (3): 89-96 191 KB

Medication – related osteonecrosis of the jaws. The first reported cases in the Baltic States and a literature review

Linas Zaleckas, Mindaugas Stacevičius, Dovilė Proškutė, Jurgita Povilaitytė

Summary

Introduction. Medication–related osteonecrosis of the jaws (MRONJ) is a severe side effect of antiresorptive or antiangiogenic therapy that manifests as an exposed bone, accompanied by clinical signs of infection, persisting for more than 8 weeks, without history of radiation therapy or metastases to the jaws. The aim of the study was to present first MRONJ cases in Lithuania and review trends in the modern research literature on the subject.

Materials and methods. We retrospectively reviewed patient charts with a diagnosis of “Inflammatory conditions of the jaws” treated in Vilnius University Hospital Žalgiris Clinic, Department of maxillofacial surgery in 2007-2014. Patients diagnosed with MRONJ were selected for the study. Demographic data, characteristics of the disease and treatment modalities were analysed.

Results. Nine cases (five male and four female) of MRONJ were analysed. The mean patient age was 69±7,9 years. Predominant primary malignancy was prostate cancer. Osteonecrotic lesions were located both in maxilla and mandible. In all cases we started with a conservative treatment first. After the antibiotic therapy with or without sequestrectomy, the condition of all patients stabilized and improved to stage I MRONJ.

Conclusion. MRONJ is a disturbing condition resulting in a severely worsened quality of life in the affected patients. This is the first case series of successfully treated patients suffering from stage II or III MRONJ in the Baltic States. A more comprehensive understanding of MRONJ will hopefully allow clinicians to enhance accuracy in risk assessment and forecast positive and negative outcomes of antiresorptive or antiangiogenic therapy.

Key words: bisphosphonate-associated osteonecrosis of the jaw, medication-associated, medication-induced, bisphosphonates, medication-related.

Received: 15 01 2015

Accepted for publishing: 28 09 2015

¹Centre of Oral and Maxillofacial Surgery, Institute of Odontology, Faculty of Medicine, Vilnius University

²Vilnius University Hospital Žalgiris Clinic

Linas Zaleckas^{1, 2} – M.D., PhD., assoc. prof.

Mindaugas Stacevičius² – D.D.S.

Dovilė Proškutė^{1, 2} – M.D.

Jurgita Povilaitytė² – D.D.S.

Address correspondence to Dr. Linas Zaleckas, Vilnius University Hospital Žalgiris Clinic, 8, Žalgirio str. 117, Vilnius LT-08217, Lithuania.

E-mail address: linas.zaleckas@zalgioklinika.lt



	Baltic Dental and Maxillofacial Journal

September, 2015, Vol. 17, No. 3 CONTENTS REVIEWS Cleft-related nose deformation evaluation and measurement methods. Literature review Ieva Bagante, Ilze Akota 75-83 SCIENTIFIC ARTICLES Neuromuscular evaluation in young patients with unilateral posterior crossbite before and after rapid maxillary expansion Cinzia Maspero, Lucia Giannini, Guido Galbiati, Laima Kairyte, Giampietro Farronato 84-88 CASE REPORTS Medication – related osteonecrosis of the jaws. The first reported cases in the Baltic States and a literature review Linas Zaleckas, Mindaugas Stacevičius, Dovilė Proškutė, Jurgita Povilaitytė 89-96 Synovial chondromatosis in the temporomandibular joint: case report with review of the literature Oksana Ivask, Edvitar Leibur, Ülle Voog-Oras 97-101 Trichoadenoma of the upper lip Gian Paolo Bombeccari, Gianpaolo Guzzi, Umberto Mariani, Andrea Gianatti, Diego Ruffoni, Franco Santoro, Francesco Spadari 102-104 © 2015 Stomatologija		Stomatologija 2015; 17 (3): 89-96 191 KB Medication – related osteonecrosis of the jaws. The first reported cases in the Baltic States and a literature review Linas Zaleckas, Mindaugas Stacevičius, Dovilė Proškutė, Jurgita Povilaitytė Summary Introduction. Medication–related osteonecrosis of the jaws (MRONJ) is a severe side effect of antiresorptive or antiangiogenic therapy that manifests as an exposed bone, accompanied by clinical signs of infection, persisting for more than 8 weeks, without history of radiation therapy or metastases to the jaws. The aim of the study was to present first MRONJ cases in Lithuania and review trends in the modern research literature on the subject. Materials and methods. We retrospectively reviewed patient charts with a diagnosis of “Inflammatory conditions of the jaws” treated in Vilnius University Hospital Žalgiris Clinic, Department of maxillofacial surgery in 2007-2014. Patients diagnosed with MRONJ were selected for the study. Demographic data, characteristics of the disease and treatment modalities were analysed. Results. Nine cases (five male and four female) of MRONJ were analysed. The mean patient age was 69±7,9 years. Predominant primary malignancy was prostate cancer. Osteonecrotic lesions were located both in maxilla and mandible. In all cases we started with a conservative treatment first. After the antibiotic therapy with or without sequestrectomy, the condition of all patients stabilized and improved to stage I MRONJ. Conclusion. MRONJ is a disturbing condition resulting in a severely worsened quality of life in the affected patients. This is the first case series of successfully treated patients suffering from stage II or III MRONJ in the Baltic States. A more comprehensive understanding of MRONJ will hopefully allow clinicians to enhance accuracy in risk assessment and forecast positive and negative outcomes of antiresorptive or antiangiogenic therapy. Key words: bisphosphonate-associated osteonecrosis of the jaw, medication-associated, medication-induced, bisphosphonates, medication-related. Received: 15 01 2015 Accepted for publishing: 28 09 2015 ¹Centre of Oral and Maxillofacial Surgery, Institute of Odontology, Faculty of Medicine, Vilnius University ²Vilnius University Hospital Žalgiris Clinic Linas Zaleckas^{1, 2} – M.D., PhD., assoc. prof. Mindaugas Stacevičius² – D.D.S. Dovilė Proškutė^{1, 2} – M.D. Jurgita Povilaitytė² – D.D.S. Address correspondence to Dr. Linas Zaleckas, Vilnius University Hospital Žalgiris Clinic, 8, Žalgirio str. 117, Vilnius LT-08217, Lithuania. E-mail address: linas.zaleckas@zalgioklinika.lt