Medical Analysis Report

1. Radiological Findings

Based on the provided CT images, the mandible (primarily the left mandibular body) shows abnormal bone structure, including local osteolytic and sclerotic changes, disordered trabecular patterns, and visible defects. Local cortical bone discontinuity or irregularity suggests necrotic or destructive lesions. The soft tissue window reveals partial soft tissue swelling, possibly related to an inflammatory response or secondary infection.

The lesion range in the mandible is concentrated in the affected area and demonstrates non-healing characteristics; compared with the surrounding normal bone, there is localized abnormal increase in bone density interspersed with osteolytic regions.

2. Potential Diagnoses

1. Bisphosphonate-Related Osteonecrosis of the Jaw (ONJ): The patient has a long-term history of bisphosphonate therapy for osteoporosis, along with mandibular pain, exposed necrotic bone, and a non-healing wound, which align with the typical features of ONJ.
2. Odontogenic or Jaw Osteomyelitis: Non-healing ulcers and bone destruction could also be caused by bacterial infection, but generally require a clear infectious source (e.g., odontogenic infection).
3. Tumor-Related Bone Destruction (Metastatic Lesions or Other Primary Malignant Tumors): The lesion appears both destructive and sclerotic; however, the patient's history and bisphosphonate use lean more toward ONJ. Malignant tumors typically present with additional systemic symptoms or radiological characteristics.

3. Final Diagnosis

Considering the patient’s age (77 years), long-term use of bisphosphonates, and the destructive, non-healing characteristics of the mandibular lesion, the most likely diagnosis is Bisphosphonate-Related Osteonecrosis of the Jaw (ONJ). If uncertainties remain, further blood tests (inflammatory markers, calcium/phosphate metabolism) and pathological biopsy (to exclude malignancies) may be performed to confirm the diagnosis.

4. Treatment Plan and Rehabilitation Program

4.1 Treatment Strategies

• Adjust or Discontinue Bisphosphonate Therapy: After thorough discussion with the bone metabolism or endocrinology department, consider halting or modifying bisphosphonate use to reduce suppression of bone tissue repair.
• Local Debridement and Infection Control: For the necrotic bone, moderate debridement surgery may be performed, along with antibiotics to control secondary infections.
• Maintain Oral Hygiene: Advise the patient to maintain diligent oral care, including mouth rinses and periodontal cleaning, to prevent or reduce infections. Local irrigation or scheduled follow-up debridement may be considered when necessary.
• Other Supportive Therapies: Such as pain management, nutritional support, and supplementation with calcium and vitamin D.

4.2 Rehabilitation/Exercise Prescription

Considering the patient’s background of osteoporosis and localized jaw lesion, a safe and gradual rehabilitation exercise plan is recommended to improve overall muscle strength and bone density while avoiding excessive load or trauma to the jaw. Below is a reference using the FITT-VP principles:

• Type: Low-impact aerobic exercises (e.g., walking, stationary biking), moderate resistance training (light dumbbells or resistance bands), and balance training (e.g., Tai Chi or standing balance exercises).
• Frequency: 3-5 times per week. For beginners or weaker individuals, start with 3 times per week and gradually increase to 5 times per week.
• Intensity: Primarily moderate or low intensity (50%-60% of maximum heart rate), allowing sustained exercise without excessive fatigue. Use light to moderate resistance during resistance training and avoid overexertion.
• Time: 20-30 minutes per session initially, progressively increasing to 30-45 minutes as tolerated.
• Progression: Provided the patient experiences no significant discomfort, exercise duration or resistance can be slightly increased every 2-4 weeks. Monitor for pain or bone discomfort and adjust accordingly.
• Volume: Adjust the total volume according to the patient’s physical condition to ensure safety and efficacy.

Prior to beginning any exercise program, ensure the patient’s blood pressure, cardiovascular status, and other relevant conditions are stable. Avoid high-impact or high-load exercises (such as running and jumping) that may increase fracture risk.

Disclaimer

This report is a reference analysis based on the existing clinical and imaging data and does not replace an in-person consultation or professional medical advice. Patients should undergo further examinations, treatments, and rehabilitation under the guidance of a specialist. Specific management plans must be individualized.