Affiliation:
1. Multiprofessional Residency Program in Oncology and Hematology Complexo Hospital de Clínicas Universidade Federal do Paraná Curitiba Brazil
2. Post Graduate Program in Dentistry Department of Stomatology Universidade Federal do Paraná Curitiba Brazil
Abstract
AbstractIntroductionMedication‐associated osteonecrosis of the jaws (MRONJ) is characterized by the presence of exposed bone or an intraoral or extraoral fistula in the maxillofacial region in patients with a history of treatment with anti‐resorptive and anti‐angiogenic drugs, such as monoclonal antibodies, and without a history of radiotherapy or metastatic diseases in the area.ObjectiveThe aim of this study is to report a case of a pathological mandibular fracture in an area of MRONJ in a patient diagnosed with Crohn's disease treated with infliximab.Case reportA 53‐year‐old male patient, an active smoker for 35 years, diagnosed with Crohn's disease, undergoing intravenous administration of infliximab 300 mg for 1 year and 3 months, with no previous history of anti‐angiogenic or anti‐resorptive medication, presenting with an extraoral fistula in the submandibular region for 4 months, with painful symptoms, diagnosed as MRONJ. He was initially treated conservatively, using antimicrobial photodynamic therapy (aPDT), antibiotic therapy, and the PENTO protocol. However, the patient evolved with a pathological fracture in the mandibular parasymphysis, requiring surgical reconstruction.Final considerationsPathological fracture of the mandible is a complication of MRONJ that compromises the patient's quality of life. The management of patients with MRONJ is complex and challenging.