Maxillofac Plast Reconstr Surg.  2016 Feb;38(2):6. 10.1186/s40902-016-0052-6.

Bisphosphonate-related osteonecrosis of the jaw in metastatic breast cancer patients: a review of 25 cases

• Kim HJ
• Park TJ
• Ahn KM

• KMID: 2158579
• DOI: http://doi.org/10.1186/s40902-016-0052-6

Abstract

BACKGROUND
Intravenous bisphosphonates have been used in metastatic breast cancer patients to reduce pathologic bone fracture and bone pain. However, necrosis of the jaw has been reported in those who received intravenous bisphosphonates. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is caused by dental extraction, dental implant surgery, and denture wearing; however, it occurs spontaneously. The purpose of this study was to report BRONJ in metastatic breast cancer patients.
METHODS
Consecutive 25 female patients were referred from the Department of Oncology from 2008 to 2014 for jaw bone discomfort. Staging of breast cancer, history of bisphosphonate infusion, etiology of BRONJ, and treatment results were reviewed. Average age of the patients was 55.4 years old (38-74). Twelve maxillae and 16 mandibles were involved. Conservative treatments such as irrigation, antibiotic medication, analgesics, and oral gargle were applied for all patients for the initial treatment. Patients who had sequestrum underwent debridement and primary closure.
RESULTS
The etiologies of BRONJ were dental extraction (19 cases), dental implant (2 cases), and endodontic treatment (1 case). However, three patients did not have any risk factors to cause BRONJ. Three patients died of progression of metastasis during follow-up periods. Surgical debridement was performed in 21 patients with success in 18 patients. Three patients showed recurred bone exposure and infection after operation.
CONCLUSIONS
Prevention of the BRONJ is critical in metastatic breast cancer patients. Conservative treatment to reduce pain, discomfort, and infection is recommended for the initial therapy. However, if there is a sequestrum, surgical debridement and primary closure is the key to treat the BRONJ.

Keyword

Bisphosphonate; Breast cancer; Bisphosphonate-related osteonecrosis of the jaw (BRONJ); Extraction; Dental implant

MeSH Terms

Analgesics
Bisphosphonate-Associated Osteonecrosis of the Jaw*
Breast Neoplasms*
Breast*
Debridement
Dental Implants
Dental Restoration Wear
Diphosphonates
Female
Follow-Up Studies
Fractures, Bone
Humans
Jaw
Mandible
Maxilla
Necrosis
Neoplasm Metastasis
Risk Factors
Analgesics
Dental Implants
Diphosphonates