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MRONJ Staging — SCE Medical Oncology MCQ

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ModerateImmunotherapy & Targeted TherapyMRONJ StagingSCE Medical Oncology

A 60-year-old man on cabozantinib for RCC develops a jaw fistula 3 months after a dental extraction. X-ray shows exposed mandibular bone. His oncologist diagnoses MRONJ. What is the AAOMS staging of this presentation?

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Correct answer: C — Stage 2 — exposed bone with evidence of infection (pain, purulent drainage, fistula); Stage 1 = exposed bone without infection; Stage 3 = exposed bone with pathological fracture, extraoral fistula or osteolysis extending to inferior border

AAOMS MRONJ staging: Stage 0 = no exposed bone but non-specific symptoms/radiographic changes; Stage 1 = exposed/necrotic bone, asymptomatic, no infection; Stage 2 = exposed bone with infection (pain, erythema, purulent drainage); Stage 3 = exposed bone with pathological fracture, extraoral fistula, or extensive osteolysis. This patient has a fistula with exposed bone = Stage 2. Management: Stage 1 = conservative (rinses, monitoring); Stage 2 = antibiotics + antiseptic rinses + consideration of surgical debridement; Stage 3 = surgical resection/reconstruction.

Reference: AAOMS MRONJ Position Paper 2022; ESMO Supportive Care; BNF