Cellulitis Extending from Submandibular to Temporal Region Originating from Bisphosphonate-related Osteonecrosis of the Mandible

Abstract

We report a case of bisphosphonate-related osteonecrosis of the jaw (BRONJ) that caused cellulitis extending from the submandibular to temporal region. An 81 year-old man was referred to our department because of trismus and painful swelling of the left mandible, for which extraction of the wisdom tooth had been performed 3 months prior. He suffered from bone metastasis of prostate cancer, and was being administered anticancer drugs and zoledronate. A physical examination revealed an exposed jaw bone, and our clinical diagnosis was BRONJ with secondary infection. Five days after his first visit, the patient suffered from rapidly increased painful swelling extending from the submandibular to temporal region. Following admission, incision of the submandibular abscess was performed and acute phase inflammation was tentatively relieved. However, painful swelling in the temporal region recurred and an incision of the temporal skin for drainage was performed, which caused persistent purulent discharge. We performed a computed tomography examination, which excluded temporal bone necrosis. Thereafter, irrigation of the abscess cavity and systemic antibiotic chemotherapy were maintained. Although the exposed jaw bone persisted, there was no further pus discharge from the incision wound and the patient was discharged 45 days after admission.

The Use of a Piezoelectric Device for the Removal of a Sequestrum Involving the Inferior Alveolar Nerve in Patients with Medication-related Osteonecrosis of the Jaws: Evaluation of Clinical Outcomes with Comparison to a Conventional Device

“…Although the treatment guideline supports conservative management of ONJ 1,3) , conservative therapy may not always lead to complete resolution of lesions. MRONJ patients who do not respond to conservative therapy occasionally display severe conditions due to prolonged infection 26) . A previous report showed that the success rate of conservative treatment ranges from less than 20% to above 50%, which is considerably lower than the therapy success rate of over 85% reported for surgical treatment 27) , and the authors advocate for surgical interventions to be considered at all MRONJ stages.…”