Pathological fracture of the coronoid process secondary to medication-related osteonecrosis of the jaw (MRONJ)

•This case reports the first case to our knowledge of pathological fracture of the coronoid process of the mandible secondary to long term use of alendronic acid.•Demonstrates the unpredictable nature of symptoms associated with medication related osteonecrosis and its management within the hospital environment.•Demonstrates the rapidly progressing and unpredictable nature of the spread of the necrotic process in medication related osteonecrosis.•Clear clinical photographs of the surgical procedure involved in the removal of necrotic bone and curettage of the surgical site in medication related osteonecrosis.

IntroductionMedication-related osteonecrosis of the jaw (MRONJ) is a growing problem within the field of oral and maxillofacial surgery. It is defined as the presence of exposed necrotic alveolar bone that does not resolve over a period of 8 weeks in a patient taking bisphosphonates, who has not had radiotherapy to the jaw [1]. Since the first report in 2003 that highlighted the potential harm caused by MRONJ, many more patients have been diagnosed with the condition [2]. The growth in recent years is likely due to the more potent drugs delivered intravenously however there is some evidence that oral bisphosphonates given over longer periods of time can have similar effects. Bone exposure may occur spontaneously or most commonly occurs following an invasive dental procedure, as shown in the case below [3].Presentation of caseThis case report demonstrates the unpredictable nature of symptoms associated with medication related osteonecrosis and its management within the hospital environment.DiscussionThis case demonstrastes the unpredictable nature of MRONJ and how the disease can progress to cause significant morbidity. In this case extensive surgery was required to remove the necrotic fragments of bone with no guarnatee that the necrosis will stop spreading.ConclusionIt seems a matter of great importance that the lasting effects of MRONJ are known to general dental and medical practitioners alike. Nationally recognised evidence based guidelines are lacking and uniformity in the management of MRONJ is required amongst the speciality.