The diagnosis and management of a pathological fracture: a case report
PDF

Keywords

Maxillofacial
Emergency medicine
Jaw

Abstract

A 64 year old female patient presented to the Accident and Emergency (A&E) department at the Royal Lancaster Infirmary (RLI) with a significant left sided jaw pain. This patient reported paraesthesia and a shooting pain radiating down her left mandible. There was also marked trismus on examination. Her medical history included a history of a previously diagnosed Squamous Cell Carcinoma (SCC) of the left soft palate. This was staged at T2N0M0 and treated with radiotherapy and chemotherapy. Following a clinical examination, special investigations via imaging were obtained prior to a formal diagnosis of pathological fracture of the left mandible following previous radiotherapy for her SCC treatment.


This case report will discuss the incidence, background, management and treatment of osteoradionecrosis (grade 3) (ORN) of the mandibular jaw bone as well as the associated pathological fractures and the detrimental effects following the use of radiotherapy to the head and neck region.

https://doi.org/10.48037/mbmj.v8i11.1328
PDF

References

Scully C. Oral and maxillofacial medicine. Edinburgh: Churchill Livingstone/Elsevier; 2021.

Nabil S, Samman N. Risk factors for osteoradionecrosis after head and neck radiation: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113(1):54-69. Available from: https://doi.org/10.1016/j.tripleo.2011.07.042

Notani K, Yamazaki Y, Kitada H, et al. Management of mandibular osteoradionecrosis corresponding to the severity of osteoradionecrosis and the method of radiotherapy. Head Neck 2003;25(3):181-186. Available from: https://doi.org/10.1002/hed.10171

Fan H, Kim S, Cho Y, et al. New approach for the treatment of osteoradionecrosis with pentoxifylline and tocopherol. Biomater Res. 2014;18:13. Available from: https://doi.org/10.1186/2055-7124-18-13

Ling M, Yosar J, Lee B, et al. The diagnosis and management of temporal arteritis. Clinical and Experimental Optometry. 2020;103(5):572-582. Available from: http://doi.org/10.1111/cxo.12975

Stack BC Jnr, Stack BC Snr. Temporomandibular joint disorder. Am Fam Physician 1992;46(1):143-50.

Di Stefano G, Maarbjerg S, Nurmikko T, Truini A, Cruccu G. Triggering trigeminal neuralgia. Cephalalgia. 2017;38(6):1049-1056. Available from: http://doi.org/10.1177/0333102417721677

Devireddy S, Kumar R, Gali R, et al. Transoral versus extraoral approach for mandibular angle fractures: a comparative study. Indian Journal of Plastic Surgery. 2014;47(03):354-361. Available from: http://doi.org/10.4103/0970-0358.146590

Pałasz P, Adamski Ł, Górska-Chrząstek M, Starzyńska A, Studniarek M. Contemporary diagnostic imaging of oral squamous cell carcinoma – a review of literature. Pol J Radiol. 2017;82:193-202. Available from: https://doi.org/10.12659/PJR.900892

Epstein J, van der Meij E, McKenzie M, et al. Postradiation osteonecrosis of the mandible: a long-term follow-up study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;83(6):657-662. Available from:https://doi.org/10.1016/s1079-2104(97)90314-0

Owosho A, Tsai C, Lee R, et al. The prevalence and risk factors associated with osteoradionecrosis of the jaw in oral and oropharyngeal cancer patients treated with intensity-modulated radiation therapy (IMRT): The Memorial Sloan Kettering Cancer Center experience. 2021. Oral Oncol. 2017;64:44-51. Available from: https://doi.org/10.1016/j.oraloncology.2016.11.015