“Phoenix Jaw”-Bone Regeneration of the Necrotic Mandible Between Pathological Fractures: An Unusual But Evocative Course of Bisphosphonate-Related Osteonecrosis

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Abstract

Management of advanced bisphosphonate-related osteonecrosis of the jaw, particularly in cases of pathological fractures with extraoral fistulas, is a challenging responsibility for craniomaxillofacial specialists. Although a periosteal reaction is occasionally observed in cases with extensive sequestra, few reports have documented circumferential periosteal osseous formation resulting in bone repair. We present the case of a 78-year-old woman who was treated for breast cancer and received intravenous bisphosphonates. She had bisphosphonate-related osteonecrosis of the jaw with bilateral pathological fractures of the mandible. During the course of minimally invasive treatment, the necrotic segment was separated with circumferential exposure, and new bone spontaneously formed with osseous union to the unilateral fractured stump. The present case typically highlights the potential of periosteal osteogenesis to regain an acceptable state even for patients with severe “bis-phossy jaw,” particularly those with pathological fractures, although we do not advocate the universality of the phenomenon presented as “phoenix jaw.”

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