Zoledronic acid
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Jaw osteonecrosis: 2 case reports A man and a woman developed jaw osteonecrosis during treatment with zoledronic acid for multiple myeloma and metastatic breast cancer, respectively. The 68-year-old man, who had been diagnosed with multiple myeloma in 2004 and had received IV zoledronic acid [Zometa] 4 mg/month for 17 months, presented with swelling and pain in his right premolar mandibular region in May 2006 [time to onset not clearly stated], about 3 months after undergoing right mandibular premolars extraction. Examination showed infection and swelling at the site of tooth extraction, but no bone exposure; a CT scan revealed bone sequestrum. Treatment included amoxicillin, clavulanic acid and fluconazole, and continued for 15 days; he also received mouth washes with chlorhexidine and hydrogen peroxide. No lesion regression was observed after 2 weeks, so minimal sequestrectomy was performed. Histopathological sections showed small bone fragments with bacterial colonies. After 1 month, the swelling and pain had completely disappeared. After 18 months of follow-up, no new lesions were observed. Since 2005, the 58-year-old woman had been receiving IV zoledronic acid 4 mg in monthly cycles. In March 2006, she presented with a 1-month history of severe pain in her left anterior maxilla; she had swelling, infection and tooth mobility on presentation [time to onset not clearly stated]. She also had severe dental plaque in her posterior left maxillary region. There was no exposed bone. A CT scan revealed bone sequestrum in her anterior maxillary region. She underwent sequestrectomy, extraction of teeth, and surgical debridement; she also received amoxicillin and clavulanic acid. Histopathological studies revealed necrosis of the bone, and superficial contamination with oral organisms. The pain had completely disappeared after 3 weeks, and there was an improvement in her oral hygiene. At 8-week follow-up, there was complete resolution of her pathology and no other oral lesions. Junquera L, et al. Nonexposed bisphosphonate-related osteonecrosis of the jaws: another clinical variant? Journal of Oral and Maxillofacial Surgery 66: 1516-1517, 801117378 No. 7, Jul 2008 - Spain
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Reactions 16 Aug 2008 No. 1215
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