Surgical intervention of osteonecrosis of the maxilla associated with bisphosphonate therapy: report of a case

Abstract

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) has a major negative effect on the quality of life of patients. However, there is still no consensus on effective treatment strategies for BRONJ. We report a case of BRONJ that was treated surgically. A 57-year-old woman who was given a diagnosis of breast cancer with multiple metastasis was referred to our clinic for evaluation of swelling of the left upper gum. Clinical examination revealed a fistulous tract with pus discharge that had developed after extraction of the upper left first molar at a dental clinic. The clinical diagnosis was an infectious bone lesion associated with bisphosphonate therapy. Conservative therapy with local irrigation and antibiotics was performed, but the lesion progressed and showed ulceration with exposed bone. We therefore determined that surgical intervention should be performed to remove the necrotic bone. A CT revealed extensive osteonecrosis of the maxila and a well demarcated interface between the necrotic and vital bone. The BRONJ was completely removed with sequestrectomy of the maxilla. Pathological evaluation confirmed necrosis of the maxilla. No evidence of metastatic disease was detected. The patient has been followed for 5 months since surgery and continues to do well.

Fatal Bleeding in Conjunction with Mandibular Medication-related Osteonecrosis of the Jaw (MRONJ)

“…Good results have been reported with aggressive surgical treatment such as reconstructive surgery following mandible detachment when no neovascularization was present 12,13,28) . Furthermore, some studies from Japan 1,2,16,30) have reported that it is possible to control ONJ by aggressive surgery or prompt reconstructive surgery in breast cancer patients on BP drugs. They also note that mandible detachment of the area affected or up to its borders may be necessary in some cancer patients, as long as the general health condition otherwise allows.…”

Usability of surgical treatment in cases of bisphosphonate-related osteonecrosis of the jaw stage 2 with sequestrum

“…Critical surgical treatment taking lesion off clearly has been effective for the cases with separated sequestrum from peripheral bone obviously. [ 18 19 ] Free sequestrum should be removed without exposing normal bone. [ 20 ] In contrast, it is difficult to remove the direct factors of non-BRONJ cases such as radio-osteonecrosis or cryptogenic osteomyelitis.…”