International Journal of Head and Neck Surgery

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VOLUME 1 , ISSUE 2 ( May-August, 2010 ) > List of Articles

CASE REPORT

Nonresolving Osteomyelitis of the Maxilla and Maxillary Sinus after Long-term Use of Oral Bisphosphonates

Ilana Kaplan, Zoe Nicolaou-Ioannou

Citation Information : Kaplan I, Nicolaou-Ioannou Z. Nonresolving Osteomyelitis of the Maxilla and Maxillary Sinus after Long-term Use of Oral Bisphosphonates. Int J Head Neck Surg 2010; 1 (2):107-110.

DOI: 10.5005/jp-journals-10001-1020

Published Online: 00-08-2010

Copyright Statement:  Copyright © 2010; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Case history

A 64-year-old woman had been treated with oral BP since 1991 for arthritic pain and osteoporosis. There were no other medical problems, no other medications used, she did not smoke nor drink alcohol.

In 2005, the left maxillary molars had been extracted. The extraction site failed to heal, but she continued to use BP. Eighteen months later she presented with swelling and pain, suppuration and an area of 2 x 1 cm of exposed necrotic bone in the left posterior maxilla and oroantral fistula (OAF).

Panoramic radiograph showed partial opacification of the maxillary sinus, unhealed extraction site, and sclerosis of adjacent maxillary alveolus. Histopathological analysis diagnosed osteomyelitis associated with actinomycosis, consistent with BRONJ.

Treatment

BP was discontinued, followed by 7 months of PO antibiotics and iodoform gauze packs. The wound seemed to be completely closed but within 2 months signs and symptoms and OAF recurred. Treatment continued with antibiotics daily rinses and weekly irrigation with Chlorhexidine 2%, and several repeated sequesterctomies, however, the patient still had pain. A course of 30 hyperbaric oxygen treatment was administered. Three years from onset symptoms improved, and sequstered bone is no longer visible. However, the OAF is still present, requiring irrigations, and the radiographs still present bony abnormality.

An unusually severe BRONJ of 3 years duration associated with 15 years oral BP use is presented.


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  1. Bisphosphonateinduced exposed bone (osteonecrosis/osteopetrosis) of the jaws: Risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg 2005;63:1567-75.
  2. Predicting risk of osteonecrosis of the jaw with oral bisphosphonate Exposure. J Oral Maxillofac Surg 2010;68:243-53.
  3. J Oral Maxillofac Surg 2009;67: 2(suppl 1).
  4. The role of surgical resection in the management of bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg 2009;67(5 Suppl):85-95.
  5. Utility of hyperbaric oxygen in treatment of bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg 2009;67(5 Suppl):96-106.
  6. Oral bisphosphonates as a cause of bisphosphonaterelated osteonecrosis of the jaws: Clinical findings, assessment of risks, and preventive strategies. Oral Maxillofac Surg 2009;67(5 Suppl):35-43.
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