Bisphosphonate-related osteonecrosis of the palatal torus

Bisphosphonates are widely used for the treatment of osteoporosis and other bone-degrading disorders; however, bisphosphonate therapy is an important risk factor for osteonecrosis of the jaws.

We report a rare case of bisphosphonate-related osteonecrosis of the palatal torus.

The patient was a 72-year-old woman with osteoporosis who had received 35 mg alendronate sodium hydrate once every week for 6 years. She had a 2-month history of oral pain because of intractable mucositis and ulceration of the palatal torus, with no history of malignant disease, radiation therapy, chemotherapy, steroid use, or recent dentoalveolar surgery. A CT scan showed a bony prominence at the midportion of the hard palate with erosion of its cortex. Her condition was diagnosed as stage 2 bisphosphonate-related osteonecrosis of the jaw caused by trauma, and she was advised to discontinue alendronate. She was prescribed oral antibiotics for 5 days and an oral antibacterial rinse. The mucositis with ulceration healed in approximately 10 weeks, but left a small scar.

Although osteonecrosis of the palatal torus associated with bisphosphonate use is a rare condition, otolaryngologists should consider this condition in the differential diagnosis of intractable ulceration of the hard palate.