Mandibular avascular osteonecrosis caused by bisphosphonate – a case report and brief review
AbstractPurpose: 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.
The submission of originals to Odonto Ciência implies the transfer by the authors of the right for publication. Authors retain copyright and grant the journal right of first publication. If the authors wish to include the same data into another publication, they must cite Odonto Ciência as the site of original publication.
CREATIVE COMMONS LICENSE
As this journal is open access, the articles are allowed free use in scientific and educational applications, with citation of the source.
According to the type of Creative Commons License (CC-BY 4.0) adopted by Odonto Ciência, the user must respect the requirements below.
You are free to:
Share — copy and redistribute the material in any medium or format.
Adapt — remix, transform, and build upon the material for any purpose, even commercially.
However, only under the following terms:
Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests Odonto Ciência endorses you or your use.
No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation.
No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.
For more details on the Creative Commons license, please follow the link in the footer of this website.