JAPANESE JOURNAL OF ORAL & MAXILLOFACIAL SURGERY

Vol. 55 No. 7       2009

ISSN: 0021-5163      UBIC: 151-J

ABSTRACT

A successful case of bisphosphonate-related osteonecrosis of the mandible treated surgically 6 months after terminating bisphosphonate treatment is reported. A 54-year-old woman was referred to our department by her dentist because of diffuse swelling of the left lower gingiva. She noticed swelling of the left molar edentulous region of the mandible, covered with a partial denture, and visited her dentist 4 months before the first visit to our department. Conservative therapy was administered, but symptoms did not improve. Thereafter, she was referred to our department because of an abscess. Her past medical history indicated that she had undergone surgical treatment for breast cancer and was receiving bisphosphonate (zoledronic acid) and hormonal preparations for the treatment of bone metastasis. Physical examination revealed sensory disturbance of the left mental region and abscess formation at the left molar region of the mandible. One month later, the bone of the lesion was exposed. Her past medical history and present illness strongly suggested bisphosphonate-related osteonecrosis of the mandible. Therefore, bisphosphonate administration was terminated, and conservative therapy with antibiotics and local irrigation was carried out. After 6 months of conservative therapy, surgical treatment and hyperbaric oxygen therapy were carried out, because radiographic examination suggested that a removable sequestrum had formed. Histopathological findings indicated a sequestrum, and the postoperative course was uneventful. Keywords: bisphosphonate, osteonecrosis of the jaw, surgical treatment, zoledronic acid.

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