Treatment of pathologic fractures of the mandible in stage III medication-related osteonecrosis of the jaw-an observational study

The treatment of pathologic fractures in stage III medication-related osteonecrosis of the jaw (MRONJ) remains challenging. The treatment in the literature is controversial, varying from extensive and aggressive surgery with resections and musculocutaneous free flap reconstruction to conservative treatment with only mouth rinses and/or antimicrobial treatment. The purpose of this study was to analyse the results of the treatment protocol in the Leiden University Medical Center in the Netherlands. Between 2003 and 2017, a total of 15 consecutive patients were seen with pathologic fractures in stage III MRONJ. Patient characteristics and treatment were studied. Seven patients were dentate, and were all surgically treated according to protocol, with 3 additionally undergoing intermaxillary fixation. Eight patients were edentulous of whom 6 were surgically treated: 2 with osteosynthesis and the rest with a soft diet post-operatively for several weeks. One patient showed healing in a later stage and was not treated. Two patients were treated with antimicrobial treatment and a soft diet. Eleven patients (73%) showed complete healing of the fracture or a pseudarthrosis and were free of complaints and able to function. These results show that a relatively simple (surgical and/or antimicrobial) approach, combined with intermaxillary fixation on occasion, can lead to consolidation and/or a pseudarthrosis with a remaining and acceptable function of the jaw.