The Whole Process Treatment Of Stage-2 Mronj:Case Report

Medication-Related Osteonecrosis of the Jaw(MRONJ)is defined as a serious complication occurring in the jaw following the use of antiangiogenic or antiresorptive medications for malignancy or osteoporosis. This case describes the treatment of Stage-2 MRONJ developed due to the use of Zoledronic acid and Denosumab with surgery combined with bone perforation and concentrated growth factor(CGF). A 70-year-old female patient was admitted to hospital with complaints of pain in mandible. The patient had been using zoledronic acid for 8 years due to lymphatic metastasis of breast cancer, and followed by denosumab for 3 years due to iliac-bone metastases.During intraoral examination, an open necrotic bone and pus discharge were exposed. Combined with CBCT examination,the patient meets stage-2 MRONJ diagnostic criteria established by AAMOS in 2014. Anti-inflammatory and chlorhexidine gargle were requested 1 day before surgery.After the necrotic bone was removed during the surgery, bone canals were prepared in the surrounding osteosclerosis area, and CGF was packed in the surgical wound. Surgery is usually adopted for MRONJ.To improve cure rate,such techniques can be combined.Firstly,bone perforation can improve blood supply of osteosclerosis area.Secondly,near-infrared fluorescence technology(ICG)can assist in ensuring the boundary of necrotic bone.Thirdly,CGF is used for severe infections and the application of infrared spectrum hyperthermia during perioperative period can reduce infection. During the follow-up session, the exposed bone was completely covered by soft tissue, resulting in smooth healing without pain.