Case of maxillary avascular necrosis due to oral bisphosphonates, presenting with signs of malignancy

Abstract

We report a rare case of avascular necrosis of the maxilla secondary to oral bisphosphonates. Case report and review of the world literature concerning avascular necrosis as a result of bisphosphonate therapy. A 62-year-old woman presented with unilateral nasal obstruction, swelling of the cheek and an ulcerating lesion of the upper alveolus. She had a past medical history of osteoporosis, for which she took oral bisphosphonates. Investigation revealed necrosis of the maxilla, and avascular necrosis secondary to oral bisphosphonates was diagnosed. There have been several documented cases of avascular necrosis of the mandible and maxilla following intravenous bisphosphonates or dental procedures. In our case, bisphosphonates were only taken orally and no dental work had been undertaken. This patient's clinical presentation was highly suggestive of malignancy, and we would like to communicate this unusual case to other otolaryngologists.