Abstract
Bisphosphonates are drugs indicated for the treatment of bone metabolic diseases or malignant hypercalcemia. They are generally well-tolerated drugs, however, recent reports have described osteonecrosis of the jaw bones as a potentially serious complication related to the long-term use of these drugs. We report a case of severe osteonecrosis in a 52-years-old white woman that was taking bisphosphonates (zoledronic acid and alendronate) for the management of osteoporosis. Following a long exposure to these drugs and after being subjected to multiples exodontias, developed bisphosphonate-related osteonecrosis of the jaw compromising the whole maxilla and that extended toward the base of skull. Due to the extent of osteonecrosis, total maxillectomy and removal of all adjacent necrotic bone were planned guided by ultraviolet light. fluorescence. This case illustrates that if not treated correctly, bisphosphonate-related osteonecrosis of the jaw may cause significant morbidity, affect the quality of life and can eventually produce significant morbidity with the dissemination to noble structures and potentially causing life-threatening complications. Key words:Osteonecrosis, bisphosphonate, bisphosphonate-associated osteonecrosis of the jaw, maxilla, osteoporosis.
Highlights
Bisphosphonates are medications indicated for the treatment of bones metabolic diseases, including osteoporosis, osteogenesis imperfecta, Paget disease or for management of malignant hypercalcemia, such as those associated with multiple myeloma; cervical, lung or mammary cancer
We report an atypical case of BRONJ extending across the maxilla and getting close to skull base
Freiberger JJ, Padilla-Burgos R, McGraw T, Suliman HB, Kraft KH, Stolp BW, et al What is the role of hyperbaric oxygen in the management of bisphosphonate-related osteonecrosis of the jaw: a randomized controlled trial of hyperbaric oxygen as an adjunct to surgery and antibiotics J Oral Maxillofac Surg. 2012;70:1573-1583
Summary
Bisphosphonates are medications indicated for the treatment of bones metabolic diseases, including osteoporosis, osteogenesis imperfecta, Paget disease or for management of malignant hypercalcemia, such as those associated with multiple myeloma; cervical, lung or mammary cancer. They are generally a well-tolerated drugs, causing few side effects, such as gastrointestinal symptoms, transient low grade fever, arthralgias and increased bone pain for the injectable drugs. Recent reports have described osteonecrosis of the jaw bones as a potentially serious complication associated with the long-term use of these drugs (1). The aim of the present study is to present an atypical case of BRONJ that, due to its severity it was necessary to perform total maxilectomy
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