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Case of maxillary avascular necrosis due to oral bisphosphonates, presenting with signs of malignancy

Published online by Cambridge University Press:  05 May 2010

R Green ,
K Blackmore  and
A Robson
R Green*
Affiliation:
Education Department Sunderland, Sunderland Royal Hospital, Carlisle, UK
K Blackmore
Affiliation:
ENT Department, Cumberland Infirmary, Carlisle, UK
A Robson
Affiliation:
ENT Department, Cumberland Infirmary, Carlisle, UK
*
Address for correspondence: Mr Richard Green, Teaching Fellows' Office, Sunderland Royal Hospital, Kayll Road, Sunderland SR4 7TP, UK. E-mail: richardgreen81@hotmail.co.uk
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Abstract

Objective:

We report a rare case of avascular necrosis of the maxilla secondary to oral bisphosphonates.

Methods:

Case report and review of the world literature concerning avascular necrosis as a result of bisphosphonate therapy.

Case report:

A 62-year-old woman presented with unilateral nasal obstruction, swelling of the cheek and an ulcerating lesion of the upper alveolus. She had a past medical history of osteoporosis, for which she took oral bisphosphonates. Investigation revealed necrosis of the maxilla, and avascular necrosis secondary to oral bisphosphonates was diagnosed.

Conclusion:

There have been several documented cases of avascular necrosis of the mandible and maxilla following intravenous bisphosphonates or dental procedures. In our case, bisphosphonates were only taken orally and no dental work had been undertaken. This patient's clinical presentation was highly suggestive of malignancy, and we would like to communicate this unusual case to other otolaryngologists.

Keywords

BisphosphonatesAvascular NecrosisMaxilla
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 12 , December 2010 , pp. 1318 - 1320
Copyright
Copyright © JLO (1984) Limited 2010

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Footnotes

Presented as a poster at the North of England ENT Meeting, 25 September 2009, Bradford, UK.

References

1Weinstein, RS, Robertson, PK, Manolagas, SC. Giant osteoclast formation and long-term oral bisphosphonate therapy. N Engl J Med 2009;360:53–62CrossRefGoogle ScholarPubMed
2Farrugia, CM, Summerlin, DJ, Krowiak, E. Osteonecrosis of the mandible or maxilla associated with the use of new generation bisphosphonates. Laryngoscope 2006;116:115–20CrossRefGoogle ScholarPubMed
3Joint Formulary Committee. British National Formulary. 56th edition. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008Google Scholar
4Mortensen, M, Lawson, W, Montazem, A. Osteonecrosis of the jaw associated with bisphonsphonates use: presentation of seven cases and literature review. Laryngoscope 2007;117:30–4CrossRefGoogle ScholarPubMed
5Marx, RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 2003;61:1115–17CrossRefGoogle ScholarPubMed
6Marx, RE. Osteoradionecrosis: a new concept of its pathophysiology. J Oral Maxillofac Surg 1983;41:283–8CrossRefGoogle ScholarPubMed
7Bagan, JV, Murillo, J, Jimenez, Y, Poveda, R, Milian, MA, Sanchis, JM et al. Avascular jaw osteonecrosis in association with cancer chemotherapy: series of 10 cases. J Oral Pathol Med 2005;34:120–3CrossRefGoogle ScholarPubMed
8Murray, DJ, Vesely, MJ, Novak, CB, Irish, J, Crump, M, Neligan, PC. Bisphosphonates and avascular necrosis of the mandible: case report and review of the literature. Plast Reconstr Surg 2008;61:94–8Google ScholarPubMed
9Herrera, D, Roldan, S, Santacruz, I, Santos, S, Masdevall, M, Sanz, M. Differences in anti-microbial activity of four commercial 0.12% chlorhexidine mouthrinse formulations: an in vitro contact test and salivary bacterial counts study. J Clin Periodontal 2003;30:307–14CrossRefGoogle Scholar