Abstract
We report a case of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with a large orocutaneous fistula in the submandibular region, which was treated with nonsegmental resection of the mandible but intraoral and extraoral surgical closure after long-term conservative treatment. As a result, we could preserve the mandible. A 75-year-old male patient diagnosed with osteoporosis, rheumatoid arthritis, diabetes mellitus and chronic sinusitis was treated with sodium risedronate hydrate for 5 years, prednisolone and bucillamine for 9 years, methotrexate for 3 years, voglibose, pioglitazone, celecoxib, rebamipide, Clarithromycin and carbocysteine. A dental practitioner had extracted his right upper first premolar, left lower second premolar and left lower first molar. Then, he visited another dental practitioner because spontaneous pain and gingival swelling persisted. He was referred to our hospital with suspicion of BRONJ because of bone exposure in the sockets. Immediately, administration of sodium risedronate hydrate was discontinued, and symptomatic treatment and washing of the sockets were started. Later, an orocutaneous fistula occurred in the submandibular region and broadened after sequestra were separated. BRONJ was improved by conservative treatment for 2 years. However, the fistula remained. We closed the fistula with a buccal gingiva-periosteal flap and filling of the platysma. One and a half years after the operation, there was no recurrence of BRONJ or fistula.
