Photobiomodulation Laser Therapy in a Lenvatinib-related Osteonecrosis of the Jaw: A Case Report

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse drug reaction often presenting as a post-surgery complication that may interfere in the quality of the patient's life. In the last decade, additionally to bisphosphonates, other drugs have been associated with MRONJ including other antiresorptive, antiangiogenic or multitarget drugs such as levantinib. The data on MRONJ associated to lenvatinib is scarce with no guidelines for best management option. Our aim is to report a case of MRONJ associated with lenvatinib and the useful of a non-invasive management using local photobiomodulation (PBM) therapy with a 635nm diode laser.

Material And Methods: A 61-year-old female patient with a follicular thyroid carcinoma (stage IV) and taking lenvatinib presented to our Oral Medicine Unit with a painful non-healing ulcer with bone exposure, in the posterior right maxilla, after an extraction of a molar tooth which occurred 4 months previously. Bone rarefaction was detected in CT scan in the same affected area. We diagnosis a lenvatinib-related osteonecrosis of the Jaw (LRONJ). We performed 5 sessions of PBM treatment using a 635 nm diode laser, delivering 10J/ cm2 in affected area.

Results: At the end of the first session, a relief in the pain was already refereed by the patient. One month after, the oral mucosa was completely healed and tissue integrity was confirmed clinically and on panoramic radiograph and the patient referred an increase in her quality of life. On the last follow up after 6 months the patient was without any recurrence.

Conclusions: A lenvatinib-related osteonecrosis of the maxilla in a female patient is reported here for the first time. Moreover, a non-invasive management using PBM laser therapy has shown a successful healing of involved tissues and immediate symptoms relief improving the quality of life of the patient. Lenvatinib, MRONJ, osteonecrosis of the jaw, tyrosine kinase inhibitors, photobiomodulation.