ABSTRACT
Jaws osteonecrosis were, in most cases, caused by external irradiation. It was otherwise a rare occurrence. However, bisphosphonates have recently been associated with osteonecrosis of the mandible or the maxilla. Bisphosphonates are widely used in the treatment of osteoporosis, multiple myeloma and osteolytic bone metastases. They inhibit bone resorption by osteoclasts and disrupt the bone turnover. The so-caused bone expositions are painful and prone to surinfection. Even after cessation of the bisphosphonates, the results of medical and surgical treatment are very inconsistent. A thorough dental check-up is recommended before initiating a course of bisphosphonates.
Subject(s)
Diphosphonates/adverse effects , Osteonecrosis/chemically induced , Humans , Male , Maxilla/drug effects , Maxilla/pathology , Middle Aged , NecrosisABSTRACT
INTRODUCTION: Jaw osteonecrosis is, in most cases, caused by external irradiation. It is otherwise a rare occurrence. OBSERVATION: A 52-year-old patient was referred to this hospital for several tooth extractions. In the procedure follow-up, the external aspect of the mandible was more and more exposed. This led to the spontaneous loss of a voluminous bone fragment. The patient had never undergone radiotherapy or a course of bisphosphonates but had a long-term cardio-vascular history. He had undergone endarterectomy of both carotids, an ilio-femoral by-pass, and a coronary dilatation. The diagnosis of bone infarction on a chronic osteomyelitis was made. DISCUSSION: Blood coagulation disorders are responsible for most cases of bone infarction. Other risk factors include local trauma, chemotherapy, corticoids, and bisphosphonates. Necrosis of the jawbones is rare even though these are prone to trauma and infections. Symptoms are not specific and imaging is contributive late in the evolution. The results of medical treatment (antibiotherapy, vasodilators, and hyperbaric oxygenotherapy) and surgical debridement are very inconsistent.
Subject(s)
Mandibular Diseases/diagnosis , Osteonecrosis/diagnosis , Actinomycosis/diagnosis , Chronic Disease , Follow-Up Studies , Fractures, Spontaneous/diagnosis , Humans , Infarction/diagnosis , Male , Mandible/blood supply , Mandibular Fractures/diagnosis , Middle Aged , Osteomyelitis/diagnosisABSTRACT
INTRODUCTION: Maxillo-mandibular osteonecrosis is exceptional outside a context of cervico-facial radiotherapy. Bisphosphonates are non-metabolized pyrophosphate analogues which inhibit osteoclastic activity. Bisphosphonates are prescribed for the treatment of malignant hypercalcemia, osteolysis associated with metastatic bone disease, Paget's disease and osteoporosis. Maxillomandibular osteonecrosis with bisphosphonates can be observed in 1/10000 patients, but is probably underestimated due to lack of dental examination. MATERIAL AND METHODS: We describe six cases of mandibular necrosis associated with bisphosphonates: five of them as part of their treatment regimen for a neoplastic condition and one for osteoporosis. RESULTS: Two patients developed spontaneous bone necrosis. In two others, tooth extraction preceded the onset of osteonecrosis. In the last two patients, we noted a preexisting dental infection. All the histopathological examinations showed necrotic bone colonized by Actinomyces. DISCUSSION: Bisphosphonate-induced osteonecrosis is only found in the maxillomandibular area because the jaws are the only bone in the skeleton exposed to the external environment. The mandible is rendered particularly prone to necrosis even after minor trauma because of its terminal vascularization. Careful oral examination is recommended before prescribing bisphosphonate therapy.
