Clinical investigation of bisphosphonate-related osteonecrosis of the jaws

Dept. of Oral Surgery, Sapporo Medical University School of Medicine.
Gan to kagaku ryoho. Cancer & chemotherapy 12/2009; 36(13):2587-92.
Source: PubMed


We examined the clinical features of bisphosphonate(BP)-related osteonecrosis of the jaws(BRONJ), a serious complication resulting from intravenous BP treatment for multiple myeloma and malignant tumors with bone metastasis. We retrospectively reviewed the medical records of 36 patients who received intravenous BP therapy for the above-mentioned conditions, at Sapporo Medical University Hospital between July 2006 and October 2008. BP therapy caused BRONJ in 7 of 24 patients, but did not affect the bones of the other 17 patients. The other 12 of the 36 patients involved in the study were prescribed BP only after they had undergone an oral examination and treatment for dental inflammation. Of these patients, 7 developed BRONJ with BP treatment, after tooth extraction or acute dental inflammation. Treating dental inflammation before prescribing BP prevented the development of BRONJ. BRONJ is highly intractable and does not resolve with the standard treatment for osteomyelitis. Therefore, preventive therapy, which can be achieved by cooperation between medical doctors and dentists, is currently the most effective strategy for BRONJ. Conservative treatment with antibiotics may also be useful for maintaining or improving the quality of life of BRONJ patients.

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    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. © 2013 The Hard Tissue Biology Network Association Printed in Japan, All rights reserved.
    Journal of Hard Tissue Biology 01/2013; 22(1):141-146. DOI:10.2485/jhtb.22.141 · 0.32 Impact Factor