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Medication-related osteonecrosis of the jaws: case report A 79-year-old man developed medication-related osteonecrosis of the jaws (MRONJ) following treatment with bevacizumab and ranibizumab for neovascular age-related macular degeneration (nAMD). The man, who had history of nAMD was admitted to the emergency room. He had received four injections of bevacizumab [Avastin] into his left eye 3 years before his admission and 23 consecutive intravitreal injections of ranibizumab [Lucentis] into his right eye over the past 3 years [dosages not stated; not all routes stated]. On admission, he reported painful rough area of exposed bone on the lingual side of the extraction site of the left mandibular canine and a second painful area at the extraction site of the left maxillary first molar. These lesions were present for past 3 months. Intraoral examination showed an area of exposed necrotic bone at the extraction site of the left mandibular canine accompanied by pain. Based on the findings, he was diagnosed with stage 2 MRONJ [duration of treatments to reaction onset not stated]. The man was treated with chlorhexidine rinses and was advised to avoid use of his removable partial dentures and was discharged. At the one month follow-up, the exposed necrotic bone was still visible at both the sites, along with purulent discharge and pain. Thus, he was scheduled for a surgical intervention and subsequently underwent sequestrectomy and peripheral ostectomy. This resulted in primary closure at both the sites. The sites had healed completely after 3 weeks, without any additional signs or symptoms at follow-up examinations over the next 3 months. Histopathological findings [Periodic acid–Schiff (PAS) and gram stains positive] revealed necrotic bone with multiple bacterial colonies consistent with Actinomyces [Actinomyces infection] granulation tissue, and a dense inflammatory infiltrate at the maxillary molar site. Oz I, et al. Medication-related osteonecrosis of the jaws associated with intravitreal administration of ranibizumab. International Journal of Oral and Maxillofacial Surgery 49: 803521204 1589-1591, No. 12, Dec 2020. Available from: URL: http://doi.org/10.1016/j.ijom.2020.05.017

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Reactions 12 Dec 2020 No. 1834