Recently, it has been widely known that osteonecrosis of the jaw occurs after administration of bisphosphonates, especially after surgical dental treatment.
Appropriate treatment of bisphosphonate-related osteonecrosis of the jaws (BRONJ) has not been established. Numerous recommendations contraindicate aggressive surgical treatment of BRONJ because it may trigger disease progression. We report a case of BRONJ that was treated with segmental resection of the jaw.
An 86-year-old man who took steroid hormone (trade name prednisolone) for a year and sodium risedronate hydrate (trade name Actonel; for treatment of osteoporosis) was referred to our clinic for evaluation of swelling of the jaw. Clinical examination revealed extensive bone resorption and sequenstration. The clinical diagnosis was BRONJ caused by pericoronitis of wisdom tooth. We performed incisional drainage, removal of the wisdom tooth and sepuestrectomy, but those provided temporary relief of symptoms. As symptoms recurred two months later, risedronate was discontinued immediately and intravenous antibiotic therapy was started. A radiographic examination showed a large sequenstration. Three months after the cessation, segmental resection of the diseased jawbone was performed and intravenous antibiotic therapy continued for three weeks after the surgery.
The BRONJ was completely removed and no evidence of recurrence was detected. The patient has been followed for two months since last surgery.
Conflict of interest: None declared.