Osteonecrosis of maxilla secondary to bisphosphonate therapy: a case report

Bisphosphonate chemotherapy is commonly used in the treatment of bone diseases such as osteoporosis, Paget disease, and multiple myeloma and to limit bone pain and hypercalcemia associated with malignant metastatic bone lesions. The introduction of bisphosphonate therapy has improved the quality of life in a vast majority of patients. However, since 2003 a growing number of reports have described necrotic bone lesions (bisphosphonate-associated Osteonecrosis of the jaw [BR-ONJ]) a bone lesion affecting maxillofacial bones in patients who have received high dosage chemotherapy with intravenous bisphosphonate therapy especially when the patient undergoes subsequent dental procedures. Sequential removal of sequestra as required seems to be the current conservative approach, but if large-volume debridement becomes necessary, removal of the bone sequestrum with minimal epithelial manipulation associated with topical and systemic antibiotics seem to be the treatment modality of choice. In our case, surgical salvage was performed successfully for BR-ONJ. Our experience indicates that with appropriate technique, primary surgical treatment may offer benefit to selected patients with BR-ONJ.