Challenging Orthognathic Surgery in Ehlers-Danlos Syndrome: A Successful Case with Denosumab Therapy : a case report

Background: Ehlers-Danlos Syndrome (EDS) is a heterogeneous disorder characterized by defects in collagen maturation. Patients with EDS commonly exhibit joint hypermobility, skin hyperextensibility, and tissue fragility. The syndrome can affect oral health, the vascular system, bones, teeth, periodontium, as well as the neuromuscular and joint systems. Due to reduced bone density, some EDS patients may receive antiresorptive medications, which can increase the risk of medication-related osteonecrosis of the jaw (MRONJ). Case Presentation : We report a case of a 25-year-old Iranian female with EDS and a history of denosumab therapy. She underwent bimaxillary orthognathic surgery to correct skeletal malocclusion. The procedure presented multiple challenges, including inherent bone abnormalities, prior denosumab use, and altered collagen structure, all contributing to unpredictable bone healing. Conclusion: Despite these challenges, the patient was successfully treated with bimaxillary orthognathic surgery, achieving a highly satisfactory outcome in terms of both functional rehabilitation and aesthetic improvement.