Osteonecrosis of the jaws caused by myelodysplasia: a case report

• ¹ Polytechnical University of Marche, Department of Clinical Specialistic and Dental Sciences, Italy
• ² University of Foggia, Department of Clinical and Experimental Medicine, Italy
• ³ Azienda Ospedaliero Universitaria Ospedali Riuniti, Special and Surgical Stomatology Department, Italy

Aim. We present a case of a patient affected by Osteonecrosis of the Jaw (ONJ) not related to the use of Bisphosphonates or other drugs. ONJ pathophysiology is not completely elucidated, and several hypotheses could explain its unique localization to the jaws: inflammation and infection, bone remodeling suppression, and compromised angiogenesis. The presence of all the following characteristics may suggest the presence of MRONJ: current or previous treatment with antiresorptive or biological agents; exposed bone or bone that can be probed through a fistula in the maxillofacial region that persists for more than 8 weeks; no history of head and neck radiotherapy or metastatic disease to the jaws. The patient is affected by myelodysplasia (MDS). This syndrome is a part of a heterogeneous group of clonal malignancies characterized by cytopenia arising either de novo or after the genotoxic insult of prior radio or chemotherapy. The morbidity and mortality of MDS stem from the complications of the low blood counts (infection and bleeding), or from progression to acute myeloid leukemia (AML). The aim of this report is to present a rare case of ONJ not related with use of systemic drugs. Materials and Methods. A 67-years-old man was referred to Special and Surgical Stomatology Department, “Ospedali Riuniti” Hospital of Ancona, Ancona, Italy, for 1-month pain localized in the mandible. Present medical history was significative for a diagnosis of MDS. Physical examination revealed the presence of an area of exposed bone in the right mandible. Orthopantomography revealed the presence of a large radiolucent zone in the right mandible. Treatment consisting in medical and surgical resection, with the use of PRGF in the surgical site. The medical treatment was metronidazole and tetracycline. Follow-up consists in regular clinical and radiological evaluation at 1, 2, 10 months to ascertain the absence of recurrences. Results. The patient at the first follow-up after 1 month, continue to present an ONJ lesion, smaller than lesion before the surgery. Metronidazole rinse in the affected area was started. After 2 months, the lesion was totally healed, except for an abscess. For this reason, a systemic antibiotic therapy was started. 10 months after the surgery, the patient was completely healed from ONJ and presented no signs or symptoms of the disease, although the MDS developed into AML. Discussion. In the last years there has been a rise of ONJ, mainly related to bisphosphonate and other drugs, or secondary to radiotherapy. However, osteonecrosis can occur in the absence of these agents and can be related to hematological diseases. In this report we present a case of ONJ related to MDS.