
What Causes A Lesion In Lower And Inner Gums While Treating BRONJ?

This is a rare condition associated with your medications.
Detailed Answer:
Hi,
Thank you for your query.
1. Your medications are associated with BRONJ/ MRONJ. This is a rare condition and hence it is possible that your ENT was unaware about this condition. However, this condition may also develop spontaneously after so many years of use. Hence the minor trauma of the biopsies may be a coincidence. Dental extraction or palatal surgery is more likely to cause or worsen this condition.
2. The medication should be reviewed. Stopping the medications will allow the lesions to heal in 3 to 6 months. Rarely, surgical debridement or bone grafting may be required.
3. These lesions may persist or increase if medication is continued. The chronic laryngitis and ear infections will require further investigations to find out if these are also related. Imaging with CT/MRI, Tc99m, Ga67 bone scans will be of use here, including assessing the progress of this condition.
4. Transdermal pain patches may be helpful in your case.
I hope that I have answered your queries. If you have any further questions, I will be available to answer them.
Regards.


I do agree with you on most of the points raised.
Detailed Answer:
Hi,
Thank you for writing back.
1. Yes, exposed bone after a biopsy would contribute to the development of the osteonecrosis, as would trauma, dental extraction or oral surgery.
2. The side effects of these medications are well documented, including spontaneous development of such lesions. Since this condition is rare, the co-relation is not conclusively proven. The duration of your treatment is also very long.
3. What has happened cannot be undone. Your observations as to the informed consent by your ENT Specialist are true, but unfortunate. I think your Oncologist should also review the need for prolonged treatment.
4. Biopsies are usually limited if the lesions are similar and the practice of blind biopsies is less common. It is possible that multiple excision biopsies (diagnostic and therapeutic) were attempted in good faith.
5. I do agree with you on most of the points raised.
I hope that I have answered your queries. If you have any further questions, I will be available to answer them.
Regards.


I would disagree on the laryngitis.
Detailed Answer:
Hi,
Thank you for writing back.
1. Laryngitis is a very common condition. These medications rarely cause laryngitis and though many medications cause laryngitis, even if suspected, only further investigation and treatment can rule out a connection. One episode in so many years of medication is not easy to co-relate. For example, your medications could have caused anaphylaxis. Though this is a known fact with most medications, there is no way of predicting whether this will happen to a patient or not.
2. It is agreed that BRONJ/ MRONJ is a known condition with your case history and the Oncologist should have been requested to review the medication. The fact that the biopsies can trigger this condition, while on the medications, should have been kept in mind.
3. HyperBaric Oxygen Therapy (HBOT) is another option to help heal the lesions and to try to prevent progression.
I hope that I have answered your queries. If you have any further questions, I will be available to answer them.
Regards.

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