Alendronic acid
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Painful trigeminal neuropathy and numb chin syndrome (first reports) and BRONJ in an elderly patient: case report A 68-year-old woman with osteoporosis was treated with alendronic acid and developed bisphosphonaterelated osteonecrosis of the jaw (BRONJ), painful trigeminal neuropathy and numb chin syndrome. The woman presented with mental paraesthesia and pain, and was hospitalised. She had received oral alendronic acid 70 mg/week for 4 years, which had stopped 26 months before presentation. She had undergone dental implant placement 5 years prior to presentation. BRONJ of her left posterior mandible had been diagnosed 3 years later, leading to alendronic acid withdrawal, removal of the involved implants, and clindamycin treatment. Two months later, she had undergone sequestrectomy and received further clindamycin, and 10 months later, she had undergone sequestrectomy and removal of the involved implants and left premolars. At the postoperative appointment, she had noted paraesthesia of her left chin. Five months later, she had severe pain in her left chin. Subsequently, she had reported episodes of cheek swelling, treated with clindamycin or doxycycline and hyperbaric oxygen therapy. At admission, she had constant numbness in her left chin, and pain rated at 8-10 on a 10cm visual analogue scale. Examination revealed intraoral exposed necrotic bone surrounded by swollen, suppurative, erythematous gingivae. Quantitative sensory testing demonstrated dysfunction of her left mental nerve. Stage 2 BRONJ-associated pain and trigeminal neuropathy was diagnosed. The woman received amitriptyline. Four weeks later, her pain had resolved. She underwent surgery, and 4 months later her chin numbness had improved, and closure of her gingival soft tissue was observed. Author comment: "This is the first report of mental neuropathy triggered by dental implants that induced BRONJ secondary to oral administration of alendronate for the management of osteoporosis." Zadik Y, et al. Painful trigeminal neuropathy induced by oral bisphosphonaterelated osteonecrosis of the jaw: a new etiology for the numb-chin syndrome. 803075787 Quintessence International 43: 97-104, No. 2, Feb 2012 - Israel
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Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of trigeminal neuropathy or numb chin syndrome associated with alendronic acid. The WHO ADR database contained 5 reports of trigeminal nerve disorder and 4 reports of numb chin syndrome associated with alendronic acid.
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Reactions 25 Aug 2012 No. 1416
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