The Role of Endotracheal Tube in Medication-Related Osteonecrosis of the Jaw - A Case Report

Rationale: Various traumatic risk factors have been correlated to the development of medication-related osteonecrosis of the jaw (MRONJ), with long-term use of antiresorptive or antiangiogenic medications. No previous cases of MRONJ secondary to endotracheal intubation have been reported in the oral and maxillofacial surgery literature.

Patient concerns: This case report describes a patient on long-term oral bisphosphonate therapy who presented with a nonhealing ulcer and exposed bony island along her right mandibular torus after undergoing general anaesthesia.

Diagnosis: The lesion was diagnosed to be MRONJ secondary to pressure necrosis from postendotracheal intubation. These findings are suggested to be the result of poor control of the endotracheal tube while managing the airway.

Treatment and outcomes: After treatment with antibiotics and mouth rinses, the necrotic bone spontaneously dislodged with complete mucosalisation of the exposed site within 2 weeks.

Take-away lessons: Given the severe impact of MRONJ, it is imperative to recognise and minimise all controllable risk factors associated with its development.