Palatal Perforation Due to Spontaneous Medication-Related Osteonecrosis of the Jaw

Medication-related osteonecrosis of the jaw is most commonly precipitated by surgical procedures, such as tooth extraction or dental implant placement. However, spontaneous cases without apparent inducing factors have also been reported, typically involving regions of bony prominence covered by thin mucosa. This report describes a rare case of spontaneous palatal osteonecrosis in an elderly osteoporotic patient that progressed to an oro-nasal fistula without evident anatomic vulnerability or local trauma. The patient's history of prolonged antiresorptive therapy and poorly controlled diabetes likely contributed to disease development. Through this unusual case, we aim to discuss potential etiological factors with a review of the literature.