Bulletin of Stomatology and Maxillofacial Surgery
ISSN 1829-006X
2025; 160–162
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A RARE CASE OF METHOTREXATE-RELATED OSTEONECROSIS OF MANDIBLE WITH AGGRESSIVE COURSE (CASE REPORT)

Koryun Hakobyan*

Received: 2026-04-08 · Published: 2025-09-28

© 2025 The Author(s) and the original publisher.

CC BY-NC 4.0 This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
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Original title
A RARE CASE OF METHOTREXATE-RELATED OSTEONECROSIS OF MANDIBLE WITH AGGRESSIVE COURSE (CASE REPORT)
Author
Koryun Hakobyan
Source journal
Bulletin of Stomatology and Maxillofacial Surgery
Published
2025-09-28
Licence
Creative Commons Attribution-NonCommercial 4.0 International
Original
https://doi.org/10.58240/1829006X-2025.21.9-160

Abstract

Methotrexate-related osteonecrosis of the jaws is a rare disease. It is usually diagnosed in patients with rheumatoid arthritis treated with methotrexate. The most common trigger of MTX-ONJ is odontogenic infection. Common clinical findings in these patients are exposed alveolar ridges and fistulas with purulent discharge, redness, and edema of surrounding soft tissues. Stage-1 and -2 cases are usually found. Stage-3 cases are too rare. On CBCT scans, sequestrums and bone destruction are common. The period of sequestrum formation is not prolonged as in BRONJ patients. After sequestrum formation, surgical treatment is effective, with low recurrence rates. Usually, sequestrum removal and bone debridement are proper. This study presents a rare case of stage 3 MTX-related ON of the mandible with a pathological fracture. Mandible segmental resection under general anesthesia was proper for the treatment.
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