a b s t r a c tOsteochondroma is a rare tumor of the mandibular condyle. Much confusion seems to exist in the literature in differentiating these tumors from chondromas as well as condylar hyperplasias.Due to considerable overlapping features between chondromas and condylar hyperplasia, it is likely to get misdiagnosed, thereby resulting in inadvertent errors in the treatment.A case report of a 35 year old male patient with mandibular deviation and malocclusion is presented here. He initially went unnoticed for features of an osteochondroma of the mandibular condyle but was subsequently treated for the same.
Bisphosphonate-induced osteonecrosis of the jaw [BIONJ] is a relatively new pathological condition which was first described in the year 2003. The prevalence of BIONJ in patients on oral formulations is around 0.05% within the first 3 years and increases up to 0.2% after 4 years of consumption. Proven systemic risk factors like anemia, uncontrolled diabetes, corticosteroid therapy, and chemotherapy in neoplastic diseases [e.g., high doses of methotrexate up to 30 mg daily] significantly increase the chances of acquiring BIONJ. We present three patients with osteoporosis and rheumatoid arthritis [RA] who consumed oral bisphosphonates [alendronate] for less than 1 year and developed BIONJ within 2 to 5 months of undergoing a traumatic dental procedure. The patients also gave a history of consuming low doses of methotrexate [disease-modifying anti-rheumatic drugs] up to 20 mg weekly for 4 to 10 years. No history of steroid consumption was given by any of the patients. This case series highlights the possibility of rheumatoid arthritis and low-dose methotrexate being potential risk factors for BIONJ. This may be on account of the synergistic effect of methotrexate and bisphosphonates and the pro-inflammatory state created by RA which increased the risk of acquiring BIONJ.
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