{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T19:26:00Z","timestamp":1790882760104,"version":"4.1.0"},"reference-count":18,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,12,17]]},"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:p>In 2003, Marx reported the first case of osteonecrosis of the jaw in 36 cases related to zoledronic acid or pamidronate. Painful bone exposure in the mandible or maxilla unresponsive to medical or surgical management was observed. In 2014, the American Association of Oral and Maxillofacial Surgeons proposed the term \u2018medication-related osteonecrosis of the jaw\u2019 (MRONJ). However, a non-exposed variant may also occur. MRONJ can lead to debilitating clinical sequelae with limited treatment options. We present the case of a 73-year-old woman with metastatic breast cancer and MRONJ of her mandible and maxilla following treatment with intravenous zoledronic acid and denosumab. Six months following dental extractions, she was referred to the Department of Oral and Maxillofacial Surgery for assessment of extensive necrosis of her maxilla and mandible. Extraoral draining sinuses were observed. A CT mandible showed cortical destruction with an ill-defined mixed sclerotic\u2013lucent pattern in keeping with osteonecrosis. Due to her metastatic breast cancer, the extent of her necrosis and poor performance status, free flap reconstruction of her mandible was ruled out. She was treated conservatively.<\/jats:p>","DOI":"10.1136\/bcr-2018-224455","type":"journal-article","created":{"date-parts":[[2020,1,6]],"date-time":"2020-01-06T07:45:21Z","timestamp":1578296721000},"page":"e224455","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Medication-related osteonecrosis (MRONJ) of the mandible and maxilla"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5499-415X","authenticated-orcid":false,"given":"Louise","family":"Dunphy","sequence":"first","affiliation":[{"name":"Oral and Maxillofacial Surgery, Churchill Hospital, Oxford, Oxfordshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Salzano","sequence":"additional","affiliation":[{"name":"Oral and Maxillofacial Surgery, Churchill Hospital, Oxford, Oxfordshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Gerber","sequence":"additional","affiliation":[{"name":"Oral and Maxillofacial Surgery, Churchill Hospital, Oxford, Oxfordshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Graystone","sequence":"additional","affiliation":[{"name":"Oral and Maxillofacial Surgery, Churchill Hospital, Oxford, Oxfordshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,1,5]]},"reference":[{"key":"2025082701504798000_13.1.e224455.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2009.10.010"},{"key":"2025082701504798000_13.1.e224455.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0278-2391(03)00720-1"},{"key":"2025082701504798000_13.1.e224455.3","doi-asserted-by":"crossref","first-page":"4253","DOI":"10.1200\/JCO.2003.99.132","article-title":"Bisphosphonates and oral cavity avascular bone necrosis","volume":"22","author":"Migliorati","year":"2003","journal-title":"J Clin Oncol"},{"key":"2025082701504798000_13.1.e224455.4","doi-asserted-by":"crossref","unstructured":"Ruggiero SL , Dodson TB , Fantasia J , et al . 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Safety of long-term denosumab therapy: results from the open label extension phase of two phase studies in patients with metastatic breast and prostate cancer."},{"key":"2025082701504798000_13.1.e224455.16","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1080\/17843286.2017.1348001","article-title":"Incidence of osteonecrosis of the jaw in patients with bone metastases treated sequentially with bisphosphonates and denosumab","volume":"73","author":"Loyson","year":"2018","journal-title":"Acta Clin Belg"},{"key":"2025082701504798000_13.1.e224455.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.tripleo.2010.05.067"},{"key":"2025082701504798000_13.1.e224455.18","doi-asserted-by":"publisher","DOI":"10.1080\/10428190802483778"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-224455","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T08:50:57Z","timestamp":1756284657000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-224455"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,1,5]]},"published-print":{"date-parts":[[2020,1]]}},"alternative-id":["10.1136\/bcr-2018-224455"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-224455","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1]]}}}