J Korean Assoc Oral Maxillofac Surg.  2017 Aug;43(4):272-275. 10.5125/jkaoms.2017.43.4.272.

A case of bisphosphonate-related osteonecrosis of the jaw with a particularly unfavourable course: a case report

• Viviano M
• Addamo A
• Cocca S

• KMID: 2391359
• DOI: http://doi.org/10.5125/jkaoms.2017.43.4.272

Abstract

Bisphosphonates are drugs used to treat osteoclast-mediated bone resorption, including osteoporosis, Paget disease, multiple myeloma, cancer-related osteolysis, and malignant hypercalcemia. The use of these drugs has increased in recent years as have their complications, especially bisphosphonate-related osteonecrosis of the jaw (BRONJ), which more frequently affects the mandible. Here we report a case of BRONJ with a particularly unfavorable course due to cervical inflammation that developed into necrotizing fasciitis, followed by multiorgan involvement leading to septic shock and death.

Keyword

Bisphosphonate-associated osteonecrosis of the jaw; Sepsis; Necrotizing fasciitis; Jaw fractures

MeSH Terms

Bisphosphonate-Associated Osteonecrosis of the Jaw*
Bone Resorption
Diphosphonates
Fasciitis, Necrotizing
Hypercalcemia
Inflammation
Jaw Fractures
Mandible
Multiple Myeloma
Osteolysis
Osteoporosis
Sepsis
Shock, Septic
Diphosphonates

Figure

• 

  Fig. 1 Panoramic radiograph. Radiologic image shows a fullthickness right jaw fracture.

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  Fig. 2 Computed tomography scan of the head; coronal view. Coronal view shows biphosphonate-related osteonecrosis lesions, fracture of right jaw and thickening of the soft tissue adjacent the inferior right hemimandibular surface in a 69-year-old woman with breast cancer history and treated with zoledronic acid for 23 administrations.

• 

  Fig. 3 Computed tomography (CT) scan of the head; transversal view. CT scan of the face, neck and chest was performed without contrast, showing pathological fracture of right jaw and periosteal reaction, besides mixed lytic and sclerotic lesion of the jaw.

• 

  Fig. 4 Three-dimensional computed tomography reconstruction of the head. Radiological image shows a noticeable pathological fracture of right jaw in a 69-year-old woman with breast cancer history and treated with zoledronic acid.

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