Adverse jaw outcomes from immune checkpoint inhibitors for head and neck cancer? Case reports.

This article focuses on potential adverse jaw outcomes associated with immune checkpoint inhibitor (ICI) therapy, specifically pembrolizumab, in patients treated for head and neck squamous cell carcinomas (HNSCCs) who have also received prior radiation therapy. It presents two case reports documenting osteonecrosis and pathologic mandibular fracture occurring shortly after initiation of pembrolizumab, suggesting a possible contributory role of immunotherapy alongside radiation-induced bone damage. The authors discuss the biological plausibility of ICIs affecting bone remodeling through immune system interactions, highlighting the need for further research to clarify the risk and mechanisms involved. The article emphasizes the importance of awareness among dental practitioners for timely diagnosis and management of such complications in patients undergoing combined radiation and immunotherapy for HNSCC.