Presence Of Necrotic Bone In Patients With MRONJ Stage 0

The diagnosis of medication-related osteonecrosis of the jaw (MRONJ)primarily relies on clinical history, clinical exam, and radiographic findings. However, early-stage MRONJ occurring in the maxilla often presents with nonspecific or deceptive clinical and radiographic features, posing greater diagnostic challenges compared to mandibular involvement A female patient with iliac hemangioma who treated with denosumab and bisphosphonate over a 5-year postoperative period. The patient presented with severe mobility of the left maxillary posterior teeth accompanied by gingival swelling. No evidence of bone exposure or fistula probing to the bone. Radiographic findings showed opacification of the left maxillary sinus with diffuse soft tissue hyperplasia. The case was classified as Stage 0 MRONJ in the left maxilla. After tooth extraction, however, necrotic bone was exposed at the bottom of the tooth socket, necessitating reclassification to Stage I MRONJ. Treatment included partial maxillectomy, maxillary sinus radical operation, and primary wound closure under tension-free principles. Postoperative follow-up at 6 months demonstrated complete mucosal healing with no clinical or radiographic evidence of recurrence. The unique anatomical complexity of the maxilla, particularly its proximity to the maxillary sinus, poses significant challenges in the early diagnosis of MRONJ. Necrotic bone may develop fistulae extending into the maxillary sinus or nasal cavity, yet sequestrum exposure is frequently obscured during initial clinical evaluation. This phenomenon contributes to false-negative diagnoses Clinicians should maintain heightened vigilance for persistent maxillary sinus inflammation, as it may indicate the onset of maxillary MRONJ, even without bone exposure