Etiopatogenia da fratura patológica mandibular: revisão de literatura e relatos de caso

DIAS, Kelly Bienk; VITANCORT, Anne Carolina Ferreira; COSTA, Plínio Abel Alexandre da; HARTEL, Caroline; SARAIVA, Thaís Becker de Almeida; SCHIEFFERDECKER, Sérgio Antônio

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RGO - Revista Gaúcha de Odontologia

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Sumário

REVIEW • Rev Gaúch. Odontol. 71 • 2023 • https://doi.org/10.1590/1981-86372023006020230071 copiar

Etiopatogenia da fratura patológica mandibular: revisão de literatura e relatos de caso

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

As fraturas patológicas mandibulares são aquelas provocadas por patologias que envolvem a base da mandíbula ou que ocorrem por forças de carga que seriam toleradas de forma normal caso o osso não fosse enfraquecido subjacentemente. Os pacientes com fraturas patológicas de mandíbula tendem a apresentar situações clínicas complexas, com limitação ou comprometimento ósseo causado pela patologia que dificulta a sua resolução bem como diminuição da capacidade de neoformação óssea pelas alterações de ordem sistêmica que podem restringir significativamente as alternativas terapêuticas. Desta forma, o objetivo do presente trabalho é revisar a literatura científica publicada e apresentar casos clínicos sobre tratamento e prevenção de fratura patológica mandibular. Uma revisão de literatura foi realizada a partir de relatos de caso indexados nas bases de dados MEDLINE e SCIELO com palavras-chave utilizadas de acordo com seus descritores específicos. A pesquisa resultou em dez artigos descrevendo como etiopatogenia causas classificadas como de origem infecciosa, idiopática, patologia benigna, patologia maligna e iatrogenia. A literatura preconiza que a cirurgia para o tratamento da patologia local seja a prioridade e que o defeito ósseo remanescente seja administrado da melhor maneira que o caso permitir, podendo ser corrigido em mais de um tempo cirúrgico. Os possíveis casos iatrogênicos devem ter condutas preventivas. Fraturas de etiologia maligna, idiopática, hereditária e metabólica apresentam a possibilidade de sinalização da primeira manifestação das doenças.

Termos de indexação
Odontologia; Fratura espontânea; Fraturas mandibulares

	Author	Etiopathogenesis	Classification	Medical History	Therapeutic Conduct	Comments
1	Kim et al. [²2 Kim T, Kim J, Choi J, Jo T, Shin HC, Jeong W. Reconstruction of a pathologic fracture following osteomyelitis of the mandible using a fibula osteocutaneous flap. Arch Craniofac Surg. 2021;22(2):105-109. http://10.7181/acfs.2020.00724 http://10.7181/acfs.2020.00724... ]	Osteomyelitis	Infectious	Osteoporosis	Affected segment resection and immediate reconstruction with a fibula osteocutaneous flap.	Medication-induced osteonecrosis was part of the differential diagnosis owing to the history of osteoporosis; however, the use of medication was not confirmed.
2	Yoshizawa et al. [³3 Yoshizawa K, Moroi A, Iguchi R, Takayama A, Goto J, Takayama Y, et al. An unusual case of bone regeneration of a necrotic mandible with pathologic fracture in an elderly hemodialysis patient with medication-related osteonecrosis of the jaw: a case report and review of the literature. J Med Case Rep. 2021;15(1):608. http://10.1186/s13256-021-03206-5 http://10.1186/s13256-021-03206-5... ]	Medication-induced osteonecrosis	Iatrogenic	Kidney disease, diabetes, osteoporosis, and heart disease.	Sequestrectomy	The approach was conservative because of the patient’s clinical condition. Surprisingly, even without osteosynthesis, the fracture healed, and bone regeneration was observed at the site during the 3-year follow-up.
3	Albarracin-Arjona et al. [⁴4 Albarracin-Arjona B, Rodriguez-Jara P, Montes-Carmona JF, Hernandez-Guisado JM, Gonzalez-Perez LM, Infante-Cossio P. Mandibular fracture as first sign of an occult intraosseous hemangioma. J Craniofac Surg. 2019;30(7):e681-e683. http://10.1097/SCS.0000000000005863 http://10.1097/SCS.0000000000005863... ]	Intraosseous hemangioma	Benign Pathology	-	Enucleation of the lesion and intermaxillary fixation.	-
4	O’Brien et al. [⁵5 O’Brien DC, Jones G, Yell M, McChesney J. Case report and literature review of a pathologic mandibular fracture from metastatic esophageal adenocarcinoma. Case Rep Otolaryngol. 2018;2018:7860384. http://10.1155/2018/7860384 http://10.1155/2018/7860384... ]	Metastatic lesion	Malignant Pathology	Hypertension and gastroesophageal reflux disease.	-	An incisional biopsy performed in the fracture area confirmed the diagnosis of esophageal adenocarcinoma. The patient was staged as advanced and considered inoperable.
5	Tamura et al. [⁶6 Tamura R, Maeda S, Terashi H. Reconstruction of a severe mandibular pathological fracture caused by Langerhans cell histiocytosis using a free fibula osteocutaneous flap:a case report. Case Reports Plast Surg Hand Surg. 2018;5(1):9-13. http://10.1080/23320885.2017.1421468 http://10.1080/23320885.2017.1421468... ]	Unifocal Langerhans Histiocytosis	Idiopathic	-	Resection, immediate reconstruction with fibula graft.	-
6	Xiao et al. [⁷7 Xiao X, Dai JW, Li Z, Zhang W. Pathological fracture of the mandible caused by radicular cyst: A case report and literature review. Medicine (Baltimore). 2018;97(50):e13529. http://10.1097/MD.0000000000013529 http://10.1097/MD.0000000000013529... ]	Periapical cyst	Benign Pathology	-	Cyst enucleation and osteosynthesis.	-
7	Marunick et al. [⁸8 Marunick MT, Garcia-Gazaui S, Hildebrand JM. Mandibular pathological fracture during treatment with a dynamic mouth opening device: A clinical report. J Prosthet Dent. 2016;116(4):488-491. http://10.1016/j.prosdent.2016.02.024 http://10.1016/j.prosdent.2016.02.024... ]	Osteoradionecrosis	Iatrogenic	Hypertension, stroke, and head and neck squamous cell carcinoma.	Treatment with hyperbaric oxygenation, resection and immediate reconstruction with fibula graft.	A surgical approach was performed to treat residual trismus from local radiotherapy before the occurrence of osteoradionecrosis.
8	McGoldrick et al. [⁹9 McGoldrick DM, McCarthy C, Sleeman D. Pathological fracture of the mandible. BMJ Case Rep, 2015;2015. http://10.1136/bcr-2014-208487 http://10.1136/bcr-2014-208487... ]	Impacted teeth removal	Iatrogenic	-	Osteosynthesis	A significant risk of mandibular fracture was evident before the surgery. The fracture occurred 10 days after the extraction, despite the patient being on a liquid and soft diet.
9	Naval-Gías et al. [¹⁰10 Naval-Gías L, Rodriguez-Campo F, Naval-Parra B, Sastre-Pérez J. Pathological mandibular fracture: a severe complication of periimplantitis. J Clin Exp Dent. 2015;7(2):e328-32. http://10.4317/jced.52305 http://10.4317/jced.52305... ]	Periimplantitis	Infectious	Head and neck squamous cell carcinoma	Osteosynthesis	Reconstruction with grafts due to local infection was not indicated in three cases.
10	Ahlers et al. [¹¹11 Ahlers E, Setabutr D, Garritano F, Adil E, McGinn J. Pathologic fracture of the mandible secondary to traumatic bone cyst. Craniomaxillofac Trauma Reconstr. 2013;6(3):201-4. http://10.1055/s-0033-1343782 http://10.1055/s-0033-1343782... ]	Traumatic bone cyst	Benign Pathology	-	Curettage, filling of the cystic space with a hemostatic sponge, and osteosynthesis.	-

	Etiopathogenesis	Classification	Medical History	Therapeutic Conduct	Comments
Case 1	Osteomyelitis	Infectious	Hypertension and diabetes	Resection of the necrotic area and reconstruction with iliac crest graft.	The reconstruction with an iliac crest graft was performed in a second surgical procedure owing to a local infection.
Case 2	Ameloblastoma	Benign pathology	-	Resection of the lesion and temporary stabilization with a reconstruction plate and surgical cement.	The patient had an associated infectious process, and the reconstruction with an autogenous graft was scheduled for a second surgical procedure.
Case 3	Impacted third molar	Iatrogenic	-	Exodontia and osteosynthesis.	No fracture was noted during the intraoperative period.

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[1] Assistant editor: Luciana Butini Oliveira