References

Pazianas M, Miller P, Blumentals WA, Bernal M, Kothawala P A review of the literature on osteonecrosis of the jaw in patients with osteoporosis treated with oral bisphosphonates: prevalence, risk factors, and clinical characteristics. Clin Ther. 2007; 29:1548-1558
Weldon D The effects of corticosteroids on bone: osteonecrosis (avascular necrosis of the bone). Ann Allergy Asthma Immunol. 2009; 103:91-97
FGDP UKUK: The Royal College of Surgeons of England; 2012
Allen MR, Burr DB The pathogenesis of bisphosphonate-related osteonecrosis of the jaw: so many hypotheses, so few data. J Oral Maxillofac Surg. 2009; 67:61-70
Patel V, Kelleher M, Sproat C, Kwok J, McGurk M New cancer therapies and jaw necrosis. Br Dent J. 2015; 219:(5)203-207
Nabil S, Samman N Risk factors for osteoradionecrosis after head and neck radiation: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 113:54-69
Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld Y, Gershwin ME Pathogenesis and natural history of osteonecrosis. Semin Arthritis Rheum. 2002; 32:94-124
Khan AA, Morrison A, Hanley DA Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res. 2015; 30:3-23
Kalsi JS, Abdel-Karim A, Brooke AE A rare case of osteonecrosis in the premaxilla following meningococcal-induced disseminated intravascular coagulation. J Oral Maxillofac Surg. 2012; 70:(12)2814-2818
Jones JP Coagulopathies in the pathogenesis of osteonecrosis. Orthopaeds Trauma. 1997; 11:157-163
Al-Mukhtar Y, Aga F, Hardee P Bisphosphonate related osteonecrosis of the jaw (BRONJ) secondary to an oral ulcer caused by Nicorandil. Br J Oral Maxillofac Surg. 2013; 51:e123-e124
Faibis S, Widmer R, Sapir S, Peretz B, Shapira J Meningococcal septicaemia and dental complications: a literature review and two case reports. Int J Paediatr Dent. 2005; 15:213-219
Khullar SM, Tvedt D, Chapman K, Herlofson BB Sixty cases of extreme osteonecrosis and osteomyelitis of the mandible and maxilla in a West African population. Int J Oral Maxillofac Surg. 2012; 41:(8)978-985
Seamon J, Keller T, Saleh J, Cui Q The pathogenesis of nontraumatic osteonecrosis. Arthritis. 2012; 2012

Spontaneous osteonecrosis of the maxilla

From Volume 43, Issue 6, July 2016 | Pages 563-566

Authors

Marianne Henien

BDS(Hons), MFDS RCS(Ed)

Department of Oral Surgery, Guy's Dental Hospital (marianne.henien@gstt.nhs.uk)

Articles by Marianne Henien

Vinod Patel

BDS (Hons), PhD

Consultant (Oral Surgery), Oral Surgery Department, Guy's and St Thomas' NHS Foundation Trust, London

Articles by Vinod Patel

Email Vinod Patel

Chris Sproat

BDS(Lond), MBBS(Hons), BSc(Hons), FDS RCS

Consultant (Oral Surgery), Oral Surgery Department, Floor 23, Guy's Dental Hospital, London Bridge, London, SE1 9RT, UK

Articles by Chris Sproat

Mark McGurk

MD, FRCS, DLO, FDS, RCS

Consultant, Department of Oral and Maxillofacial Surgery, Guy's, King's and St Thomas' Dental Institute, SE1 9RT, UK

Articles by Mark McGurk

Abstract

In the past decade there has been a rise of osteonecrosis of the jaws (ONJ) predominately related to bisphosphonate therapy and osteoradionecrosis secondary to radiotherapy. However, osteonecrosis can occur in the absence of these agents. A case of idiopathic osteonecrosis of the maxilla is reported and the literature discussed.

CPD/Clinical Relevance:It is not always possible to make a definitive diagnosis.

Article

Osteonecrosis of the jaw (ONJ) is identified as ‘non-healing exposed necrotic bone in the maxillofacial region’.1 ONJ has received much publicity in the dental literature recently owing to its induction via various identified medications, eg bisphosphonates, denosumab and bevacizumab, and has now led to the new accepted acronym of MRONJ (Medication Related OsteoNecrosis of the Jaw). Radiotherapy is also a common cause for ONJ and is referred to as OsteoRadioNecrosis (ORN). There remain other causes for ONJ but these are uncommon. A spontaneous case of ONJ due to vascular ischaemia is presented.

A 94-year-old-male was referred by his general dental practitioner to the Head and Neck clinic at Guy's Hospital due to exfoliation of his upper central incisors and exposed non-healing bone in the premaxilla, as a malignant process was suspected. Prior to exfoliation of the teeth, the patient experienced spontaneous intra-oral bleeding from the maxillary midline region.

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