ATYPICAL SINUSITIS IN A PATIENT ON ANTI-RESORPTIVE MEDICATION: A CASE REPORT

Abstract

<h3>BACKGROUND</h3> Skeletal complications and bone loss resulting from giant cell tumor (GCT) of the bone are uncommon.¹ However, GCT can be locally aggressive and lead to surgical resection. Antiresorptive medications are used in these patients to reduce the risk of complications. <h3>CASE REPORT</h3> A 50-year-old male patient presented to the Oral Medicine clinic at the University of Florida College of Dentistry with the chief complaint of discomfort and swelling in the left maxillary region. The patient had been on various antiresorptive medications including Zometa. Clinical examination demonstrated an intraoral fistula on the left side of the maxilla in the non-keratinized gingiva. After correlation with the patient's medical history, medication-related osteonecrosis of the jaw (MRONJ) was suspected. A complete opacification and dystrophic calcification within the left maxillary sinus were noted on cone beam computed tomography. There were disruptions of the posterior and anterior walls of the maxillary sinus. The radiographic findings were consistent with chronic sinusitis with possible fungal infection. The possibility of MRONJ or a malignant neoplasm was also included. Histopathologic analysis revealed chronic inflammation and polypoid tissue with viable reactive bone. After endoscopy and histopathologic evaluation, the patient was prescribed 300 mg chlorhexidine and sodium chloride solution. <h3>DISCUSSION/CONCLUSIONS</h3> There are reports of sinus involvement with MRONJ if the radiograph shows unilateral mucoperiosteal thickening, sinus opacification, and fistula formation. These findings may mimic sinusitis. The patient had these radiographic findings as well as discontinuity of the sinus boundaries.