Extraoral manifestation not uncommon in osteonecrosis of the jaw

Medication-related osteonecrosis of the jaw (MRONJ), a major side effect of using bone-modifying agents (BMA) for cancer or osteoporosis, normally manifests intraorally. However, some patients may have an extraoral manifestation of erythematous swelling or fistulas localized to the jaw area, according to a recent study.

“Primary care physicians should consider MRONJ as a differential diagnosis in such patients,” the authors said.

Medical records of patients diagnosed with MRONJ between 2003 and June 2020 were retrieved from the Oral Medicine Unit of The Sheba Medical Center in Israel. The authors then obtained data pertaining to demographics, medical background, BMA type, and clinical presentation.

A total of 515 patients (mean age 65 years, 73 percent women) met the eligibility criteria. Of these, 84 (16.5 percent) presented with extraoral manifestations of MRONJ. Twenty-one of the 84 patients (24.7 percent) also had extraoral fistulas. Notably, a robust association was observed between extraoral manifestations and MRONJ of the mandible (n=67; p=0.0006).

“MRONJ is a side effect in patients undergoing treatment with BMA for cancer or osteoporosis,” the authors said. “Although most cases are treated by oral medicine specialists, some cases may present extraorally as a fistula in the skin or erythematous swelling localized to the jaw area, causing these patients to consult a primary care physician.”