Yoon Michelle, Ramirez Ricardo, Yun Jun, Wiedmer Christina, Brandwein-Weber Margaret, Khorsandi Azita S, Buchbinder Daniel, Khan Mohemmed N
Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA.
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Head Neck. 2025 Jan;47(1):E1-E10. doi: 10.1002/hed.27974. Epub 2024 Oct 28.
Bisphosphonates (BPs) are widely used for osteoporosis and cancer-induced bone diseases due to their antiresorptive properties, yet they pose risks such as medication-related osteonecrosis of the jaw (MRONJ).
We present a unique case of concurrent oral squamous cell carcinoma (SCC) and MRONJ in a 72-year-old female chronically treated with oral ibandronate for osteoporosis. Following a dental extraction, she developed a nonhealing wound in the maxilla. Following conservative treatment, the patient underwent a maxillectomy and extensive tissue reconstructions to control her infection and address suspicions of an underlying malignancy.
Histopathological examinations confirmed simultaneous osteonecrosis and well-differentiated SCC in the maxillary sinus and surrounding tissues. Despite multiple surgeries, the patient's disease progressed rapidly. Upon examining the literature for patients with a history of BP use diagnosed with MRONJ and/or SCC, a total of 16 cases report a diagnostic dilemma between MRONJ and locoregional SCC. Three of the 16 cases report a final diagnosis of concurrent MRONJ and SCC. This report is the fourth reported case of concurrency to date.
The patient's complex clinical course underscores the diagnostic challenges and therapeutic dilemmas in managing concurrent MRONJ and SCC, highlighting the need for vigilant monitoring and interdisciplinary collaboration in similar cases.
双膦酸盐（BPs）因其抗吸收特性而被广泛用于治疗骨质疏松症和癌症引起的骨疾病，但它们也带来了诸如药物相关性颌骨坏死（MRONJ）等风险。
我们报告了一例独特的病例，一名72岁女性长期口服伊班膦酸钠治疗骨质疏松症，同时患有口腔鳞状细胞癌（SCC）和MRONJ。拔牙后，她上颌出现了不愈合的伤口。经过保守治疗后，患者接受了上颌骨切除术和广泛的组织重建，以控制感染并排除潜在恶性肿瘤的怀疑。
组织病理学检查证实上颌窦及周围组织同时存在骨坏死和高分化SCC。尽管进行了多次手术，患者的病情仍迅速进展。在查阅有BP使用史且被诊断为MRONJ和/或SCC的患者的文献时，共有16例报告了MRONJ和局部SCC之间的诊断困境。16例中有3例最终诊断为MRONJ和SCC并发。本报告是迄今为止第四例并发病例报告。
患者复杂的临床病程凸显了在处理MRONJ和SCC并发时的诊断挑战和治疗困境，强调了在类似病例中进行密切监测和跨学科协作的必要性。
