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Successful treatment of osteonecrosis-induced fractured mandible with teriparatide therapy: A case report.

Yao M, Shimo T, Ono Y, Obata K, Yoshioka N, Sasaki A - Int J Surg Case Rep (2016)

Bottom Line: To date, there is no established treatment for cases of advanced stage 3 MRONJ osteoporosis in elderly patients.Teriparatide may have a powerful anabolic effect on bone, and promote bone regeneration against pathologic mandible fracture induced by MRONJ.Based upon these findings, teriparatide might be beneficial for advanced stage 3 MRONJ osteoporosis in elderly patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8525, Japan.

No MeSH data available.


Related in: MedlinePlus

Computed tomography at the first medical examination.
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fig0010: Computed tomography at the first medical examination.

Mentions: An 87-year-old woman with a 2-year history of minodronic acid hydrate (50 mg/4 w orally) for the treatment of osteoporosis was referred to us in 2013 for treatment of a pathological mandibular fracture. She had undergone extraction of the left mandibular first molar 5 months earlier, and underwent oral irrigation for the intraoral fistula at another hospital. She had an incomplete occlusion of the denture, and movement of the mandible bony fragment. The infection of the soft tissue and mandible had extended to the inferior border of the left mandible and emerged as an extraoral fistula (Fig. 1). Computed tomography revealed osteolysis extending to the inferior border resulting in a pathological fracture of the left mandible (Fig. 2). A biopsy was done and the histology revealed chronic inflammation and sequestrum. She was diagnosed with stage 3 BRONJ. She had a vertebral compression fracture concurrently and had started subcutaneous injection of teriparatide (56.5 μg/week) 1 month earlier. After discussion with the family physician, teriparatide treatment was continued and conservative treatment including amoxicillin hydrate administration (750 mg/d) initiated. Six months after the initiation of teriparatide therapy, bone sequestration of the left mandible had occurred, and the patient was receiving intraoral sequestrectomy under local anesthesia. After 7 months of the treatment, her symptoms had resolved and the intraoral and extraoral fistula had been converted to normal mucosa and skin respectively; therefore, administration of the antibiotic was discontinued. After 18 months of treatment with teriparatide, computed tomography showed significant bone regeneration and recovery of the mandible bone continuity (Fig. 3). Thereafter, she obtained functional recovery of the occlusion by complete dentures (Fig. 4).


Successful treatment of osteonecrosis-induced fractured mandible with teriparatide therapy: A case report.

Yao M, Shimo T, Ono Y, Obata K, Yoshioka N, Sasaki A - Int J Surg Case Rep (2016)

Computed tomography at the first medical examination.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834826&req=5

fig0010: Computed tomography at the first medical examination.
Mentions: An 87-year-old woman with a 2-year history of minodronic acid hydrate (50 mg/4 w orally) for the treatment of osteoporosis was referred to us in 2013 for treatment of a pathological mandibular fracture. She had undergone extraction of the left mandibular first molar 5 months earlier, and underwent oral irrigation for the intraoral fistula at another hospital. She had an incomplete occlusion of the denture, and movement of the mandible bony fragment. The infection of the soft tissue and mandible had extended to the inferior border of the left mandible and emerged as an extraoral fistula (Fig. 1). Computed tomography revealed osteolysis extending to the inferior border resulting in a pathological fracture of the left mandible (Fig. 2). A biopsy was done and the histology revealed chronic inflammation and sequestrum. She was diagnosed with stage 3 BRONJ. She had a vertebral compression fracture concurrently and had started subcutaneous injection of teriparatide (56.5 μg/week) 1 month earlier. After discussion with the family physician, teriparatide treatment was continued and conservative treatment including amoxicillin hydrate administration (750 mg/d) initiated. Six months after the initiation of teriparatide therapy, bone sequestration of the left mandible had occurred, and the patient was receiving intraoral sequestrectomy under local anesthesia. After 7 months of the treatment, her symptoms had resolved and the intraoral and extraoral fistula had been converted to normal mucosa and skin respectively; therefore, administration of the antibiotic was discontinued. After 18 months of treatment with teriparatide, computed tomography showed significant bone regeneration and recovery of the mandible bone continuity (Fig. 3). Thereafter, she obtained functional recovery of the occlusion by complete dentures (Fig. 4).

Bottom Line: To date, there is no established treatment for cases of advanced stage 3 MRONJ osteoporosis in elderly patients.Teriparatide may have a powerful anabolic effect on bone, and promote bone regeneration against pathologic mandible fracture induced by MRONJ.Based upon these findings, teriparatide might be beneficial for advanced stage 3 MRONJ osteoporosis in elderly patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8525, Japan.

No MeSH data available.


Related in: MedlinePlus