Bisphosphonate related osteonecrosis of the maxilla: A case report

Bisphosphonates are group of medication which have an important role in treatment of some bone diseases. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is side effect of intravenous bisphonate therapy. The mechanism of action by which they may cause osteonecrosis is questionable. BRONJ is defined by AAOMS (American Association od Oral and Maxillofacial Surgeon) and classified into four stages (0-3). Treatment of BRONJ depends on the stage of disease and includes conservative treatment (stage 0 and 1) and surgical treatment (surgical debridment in stage 2 and sequestrectomy in stage 3). Authors present patient who had brest cancer, with stage 3 of bisphosphonate-related osteonecrosis of the upper jaw after zolendroic acid therapy for diffuse metastasis of the vertebrae. Before treatment with zolendroic acid the patient was treated by a dentist. The osteonecrosis of the upper jaw started a year and a half after the start of zolendroic acid therapy and after tooth 24 extraction. She was treated by oral surgeon at the beginning according to the protocol of AAOMS. The patient was sent to maxillofacial surgeon due to disease progression, and after CT diagnostic resection of the upper jaw was done. BRONJ is condition with specific clinical presentation, and it can be vey serious for the patient, therefore it is necessary to emphaze the importance of scereening. The doctors in different specialties ( oncologist, dentis, oral surgeon and maxillofacial surgeon) must cooperate and control the patients under treatment with bisphosphonates before therapy starts, as well as during and after it , in order to prevent, recognize on time and treat properly this complication.