Long-term Therapeutic Processing of Various Bonerelated Conditions in Bisphosphonate-related Osteonecrosis of the Jaw: A Case Report

Abstract

Bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) occurs when an uncovered area of the jawbone in the oromaxillary region has not healed within 8 weeks. Patients who have not previously undergone radiation therapy in the craniofacial region but received BP therapy. BRONJ is believed to be caused by trauma to dentoalveolar structures, which have a limited capacity for bone healing because of the effects of BP therapy. BRONJ typically manifests as incomplete healing of an extraction socket, exposed bone, sequestrum, and fistula tract formation involving the maxillofacial structures. This article reports the case of a 40-year-old woman with breast cancer involving bone metastasis who had undergone 3 years of therapy with zoledronic acid. She complained of a painful unhealed wound at the left mandible, which formed after having a tooth extracted one year ago. The management strategies for this patient were discontinuing BP therapy, using oral antimicrobial rinses alone and in combination with antibiotic therapy, and debridement which may achieve long-term palliation with resolution of acute infection and pain. The patient underwent 45 months of long-term therapeutic processing, and the healing of the wound sometimes improved, and sometimes worsened. Currently, the wound has healed effectively and the patient has been followed up closely.