Necrosis BRONJ of the mandible, complicated by Actinomyces infection – Case Report
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Department of Maxillofacial Surgery. Medical University of Lublin, Poland
Medical University of Lublin, Poland
Corresponding author
Anna Gaweda   

Department of Maxillofacial Surgery. Medical University of Lublin, The Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland, 20-081 Lublin, Poland
J Pre Clin Clin Res. 2018;12(3):82-86
Biphosphonate-related osteonecrosis of the jaw (BRONJ) is a common complication of the therapy of malignant cancers. Drugs improve bone density and reduce hypercalcaemia in patients with primary tumours, as well as their metastases to the bones. A characteristic feature are emerging foci of osteonecrosis of the jaws, with secondary infection which is often actinomycotic. Actinomyces are Gramm-positive bacteria which colonize the mucous membrane and in favourable conditions are the cause of inflammation. BRONJ appears spontaneously or may be a consequence of surgical treatment in the area of the jaws. The case is presented of an 82-year-old woman after hysterectomy due to a cancerous lesion who had taken ibandronic acid for a long time. Because of the severe pain in the mandible and the advanced disease, surgical sequestration of the necrosis and antibiotic treatment of the actinomycosis were necessary.
Gómez Font R, Martínez García ML, Olmos Martínez JM, Osteochemonecrosis of the Jaws due to Bisphosphonate Treatments. Update, Med Oral Patol Oral Cir Bucal. 2008 May 1; 13(5): E318–24.
Kim T-H, Seo W-G, Koo C-H, Lee J-H. Evaluation of the predisposing factors and involved outcome of surgical treatment in bisphosphonate-related osteonecrosis of the jaw cases including bone biopsies. Journal of the Korean Association of Oral and Maxillofacial Surgeons. 2016; 42(4): 193–204. doi:10.5125/jkaoms.2016.42.4.193.
Campisi G, Fedele S, Fusco V, et al. Epidemiology, clinical manifestations, risk reduction and treatment strategies of jaw osteonecrosis in cancer patients exposed to antiresorptive agents, Future Oncol. 2014 Feb; 10(2): 257–75. doi: 10.2217/fon.13.211.
Gawęda A, Czerkies R, Trzaskowska E, Tomaszewski T. Bisphosphonate-related osteonecrosis of the jaw in a 66-year-old female – Case report.mJ Pre-Clin Clin Res. 2017; 11(2): 162–166. doi: 10.26444/jpccr/80726.
Jeong H-G, Hwang JJ, Lee J-H, Kim YH, Na JY, Han S-S. Risk factors of osteonecrosis of the jaw after tooth extraction in osteoporotic patients on oral bisphosphonates. Imaging Science in Dentistry. 2017; 47(1): 45–50. doi:10.5624/isd.2017.47.1.45.
Ruggiero SL, Dodson TB, Fantasia J, et al. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw-2014 update. J Oral Maxillofac Surg. 2015; 73: 1440. doi: 10.1016/j.joms.2015.04.023.
Nair V, BRONJ: What Should a Dental Surgeon Know?, International Medical Journal Vol. 24, No. 1, pp. 117–119, February 2017.
Naik NH, Russo TA, Bisphosphonate-Related Osteonecrosis of the Jaw: The Role of Actinomyces, Clin Infect Dis. 2009 Dec 1; 49(11): 1729–32. doi: 10.1086/648075.
Fukushima Y, Enoki Y, Nakaoka C, et al. Usability of surgical treatment in cases of bisphosphonate-related osteonecrosis of the jaw stage 2 with sequestrum. Annals of Maxillofacial Surgery. 2015; 5(1): 67–70. doi: 10.4103/2231-0746.161067.
Vidal-Gutiérrez X, Gómez-Clavel JF, Gaitán-Cepeda LA. Dental extraction following zoledronate, induces osteonecrosis in rat's jaw. Med Oral Patol Oral Cir Bucal. (2017), doi: 10.4317/medoral. 21609.
Bagan L, Jiménez Y, Leopoldo M, Rubert A, Bagan J. Exposed necrotic bone in 183 patients with bisphosphonate-related osteonecrosis of the jaw: Associated clinical characteristics. Med Oral Patol Oral Cir Bucal. (2017), doi: 10.4317/medoral.22133.
Nicolaou-Ioannou Z, Kaplan I, Nonresolving Osteomyelitis of the Maxilla and Maxillary Sinus after Long-term Use of Oral Bisphosphonates, International Journal of Head and Neck Surgery, May-August 2010; 1(2): 107–110.
Omami M, Ben Ali R, Sioud S, Hentati H, Selmi J, Incidence and Risk Factors of Bisphosphonate-Related Osteonecrosis of the Jaw Following Tooth Extraction: A Systematic Review, Sch J App Med Sci. 2017; 5(10F): 4276–4283. doi 10.21276/sjams.2017.5.10.90.
López-D’alessandro E, Mardenlli F, Paz M. Oral bisphosphonate-associated osteonecrosis of maxillary bone: A review of 18 cases. Journal of Clinical and Experimental Dentistry. 2014; 6(5): e530–e534. doi: 10.4317/jced.51694.
Black DM, Reid IR, Boonen S, et al. The Effect of 3 Versus 6 Years of Zoledronic Acid Treatment of Osteoporosis: A Randomized Extension to the HORIZON-Pivotal Fracture Trial (PFT). Journal of Bone and Mineral Research. 2012; 27(2): 243–254. doi:10.1002/jbmr.1494.
Leite AF, Ogata Fdos S, de Melo NS, Figueiredo PT, Imaging Findings of Bisphosphonate-Related Osteonecrosis of the Jaws: A Critical Review of the Quantitative Studies, Int J Dent. 2014; 2014: 784348 doi: 10.1155/2014/784348. Epub 2014 Jun 11.
Krstevska S, Stavric SG, Cevrevska L, et al. Osteonecrosis of the Jaw After Bisphosphonates Treatment in Patients with Multiple Myeloma. Medical Archives. 2015; 69(6): 367–370. doi: 10.5455/medarh.2015.69.367-370.
Hellstein JW, Adler RA, et al. Managing the care of patients receiving antiresorptive therapy for prevention and treatment of osteoporosis Executive summary of recommendations from the American Dental Association Council on Scientific Affairs, JADA 2011; 142(11): 61243–1251.
Sanchis JM, Bagán JV, Murillo J, Díaz JM, Asensio L, Risk of developing BRONJ among patients exposed to intravenous bisphosphonates following tooth extraction. Quintessence Int. 2014 Oct; 45(9): 769–77. doi: 10.3290/j.qi.a32243.
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