Mandibular avascular osteonecrosis caused by bisphosphonate – a case report and brief review

  • Gustavo Lisboa Martins UFRGS
  • Edela Puricelli UFRGS
  • Marcel Fasolo de Paris UFRGS
  • Deise Ponzoni UFRGS
  • Carlos Eduardo Espíndola Baraldi UFRGS
Keywords: osteonecrosis, biphosphonates, zoledronic acid

Abstract

Purpose: To present a case of total bilateral jaw necrosis in a patient with primary breast cancer and bone metastases treated with zeledronic acid and discuss the adverse effects of biphosphonates and the best moment to perform dental procedures. Case description: A female patient, 62 years old, with primary breast adenocarcinoma underwent chemotherapy and zoledronic acid because of bone metastases on the right hip. After 7 months, she was submitted to debridement of exposed bone on the anterior mandible, which resulted in skin fistulae and severe pain. Computerized tomography showed bone sequestration hypodensity at the right and left mandibular body and mentum with excessive uptake of the labeled drug as seen by bone scintigraphy. The patient received amoxicillin, gluconate and chlorhexidine mouthrinse and hydrogen peroxide; partial closure of skin fistulae was achieved. After 4 months, the patient returned with submandibular tissue necrosis, intra- and extra-orally exposed mandible with active discharge. After 5 days of palliative treatment, the patient died from sepsis. Conclusion: Local infection/inflammation should be treated before the use of biphosphonates, and topic and systemic pharmacologic treatment should be combined with a strict follow-up. For selected cases, the osteonecrosis treatment may include conservative debridement, pain control, topic and systemic antimicrobial control, and, in extremely severe cases, radical surgery.

Author Biographies

Gustavo Lisboa Martins, UFRGS
Aluno do Programa de Pós-Graduação em Clínicas Odontológicas – Nível Doutorado - Cirurgia e Traumatologia Buco-Maxilo-Faciais – Faculdade de Odontologia - Universidade Federal do Rio Grande do Sul – Porto Alegre/RS-Brasil.
Edela Puricelli, UFRGS
Professora do Programa de Pós-Graduação da Faculdade de Odontologia - Universidade Federal do Rio Grande do Sul; Chefe da Unidade de Cirurgia e Traumatologia Buco-Maxilo-Faciais – Hospital de Clínicas de Porto Alegre – Porto Alegre/RS-Brasil.
Marcel Fasolo de Paris, UFRGS
Professor Adjunto do Departamento de Cirurgia e Ortopedia da Faculdade de Odontologia - Universidade Federal do Rio Grande do Sul – Porto Alegre/RS-Brasil.
Deise Ponzoni, UFRGS
Professora Adjunta do Departamento de Cirurgia e Ortopedia da Faculdade de Odontologia - Universidade Federal do Rio Grande do Sul – Porto Alegre/RS-Brasil.
Carlos Eduardo Espíndola Baraldi, UFRGS
Professor Adjunto da Faculdade de Odontologia - Universidade Federal do Rio Grande do Sul – Porto Alegre/RS-Brasil.
Published
2009-07-17
Section
Case Report