Successful Non-surgical Management of a Mandible Fracture Secondary to Medication-related Osteonecrosis of the Jaw: A Unique Case Report

Background: Medication-related osteonecrosis of the jaw (MRONJ) may be a severe side effect of bone-modifying agents. Objective: Pathologic fractures treatment in patients with MRONJ remains challenging. The authors reported a unique case of successful non-surgical management of a mandible fracture secondary to MRONJ. Methods: A 78-year-old osteoporotic woman with a 4-year history of oral bisphosphonate therapy and a compromised dental condition developed an MRONJ-related right mandibular body fracture. Treatment consisted of systemic antibiotic administration (amoxiclav and metronidazole) and chlorhexidine mouthwash. Results: Follow-up visits revealed progressive healing of the mandibular fracture with bone callus formation and complete recovery of the ipsilateral lip and chin sensitivity after one year. Conclusion: Non-surgical management of pathological fractures related to MRONJ might be of interest in patients that refuse any type of surgery, but preventive measures, such as careful dental examination, should be taken before start antiresorptive therapy and during the treatment. The authors reported the first case in the literature of successful management of a mandibular fracture secondary to MRONJ with only antibiotics and mouthwashes.