Abstract
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a condition found in patients taking bisphosphonate therapy for different bone-related conditions. A 68-year-old male patient was receiving zolendronic acid to treat prostate bone metastasis and underwent a surgical extraction of inferior tooth. The patient was referred to our department presenting with an extraoral fistula in the submandibular region with erythematous tumefaction and associated pain. The intraoral exam revealed a fistula with purulent drainage, without bone exposure, located in the area of tooth extraction. Imaging exams showed a radiolucent lesion with irregular aspects and ill-defined margins. Histologic analysis revealed fragments of necrotic lamellar osseous tissue. Based on these findings, a diagnosis of BRONJ, stage 3 was confirmed. The surgical approach was indicated in association with antibiotic therapy and use of pentoxifylline, tocopherol, photodynamic therapy, and hyperbaric oxygen therapy. After 1 year of follow-up examinations, the radiography and clinical examination showed resolution of the case.
Published Version
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