2019 Volume 65 Issue 11 Pages 757-762
Osteonecrosis of the jaw is a problematic side effect of bisphosphonates or angiogenesis inhibitors. Reports on surgical therapy for medication-related osteonecrosis of the jaw (MRONJ) have recently been published. However, surgical treatment of MRONJ is often difficult for patients undergoing cancer treatment who have poor general status. Oral ingestion becomes difficult, and the quality of life (QOL) declines in patients with progressive MRONJ. We describe a patient with renal cancer who had deteriorated general status due to MRONJ and was treated by mandibular resection and immediate reconstruction. A 75-year-old man treated with bisphosphonate and sunitinib for renal cancer presented with exposed mandibular bone, renal hypofunction, and hyperkalemia due to frequent use of an analgesic. We removed the sequestrum, which allowed oral ingestion and improved his general status. Then, mandibular resection and immediate reconstruction with a free-fibula flap were performed to prevent pathological fractures. However, sunitinib seemed to cause delayed wound healing. Given the cessation period of angiogenesis inhibitors and the amount of time required for wound healing, this surgical approach to MRONJ seemed useful for maintaining the QOL of this patient with renal cancer.
