Mandibular avascular osteonecrosis caused by bisphosphonate – a case report and brief review
Autor(a) principal: | |
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Data de Publicação: | 2009 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Revista odonto ciência (Online) |
Texto Completo: | https://revistaseletronicas.pucrs.br/ojs/index.php/fo/article/view/4859 |
Resumo: | Purpose: To present a case of total bilateral jaw necrosis in a patient with primary breast cancer and bone metastases treated with zeledronic acid and discuss the adverse effects of biphosphonates and the best moment to perform dental procedures. Case description: A female patient, 62 years old, with primary breast adenocarcinoma underwent chemotherapy and zoledronic acid because of bone metastases on the right hip. After 7 months, she was submitted to debridement of exposed bone on the anterior mandible, which resulted in skin fistulae and severe pain. Computerized tomography showed bone sequestration hypodensity at the right and left mandibular body and mentum with excessive uptake of the labeled drug as seen by bone scintigraphy. The patient received amoxicillin, gluconate and chlorhexidine mouthrinse and hydrogen peroxide; partial closure of skin fistulae was achieved. After 4 months, the patient returned with submandibular tissue necrosis, intra- and extra-orally exposed mandible with active discharge. After 5 days of palliative treatment, the patient died from sepsis. Conclusion: Local infection/inflammation should be treated before the use of biphosphonates, and topic and systemic pharmacologic treatment should be combined with a strict follow-up. For selected cases, the osteonecrosis treatment may include conservative debridement, pain control, topic and systemic antimicrobial control, and, in extremely severe cases, radical surgery. |
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Mandibular avascular osteonecrosis caused by bisphosphonate – a case report and brief reviewOsteonecrose avascular de mandíbula por uso de bisfosfonato – relato de caso e breve revisãoosteonecrosisbiphosphonateszoledronic acidOncologyPurpose: To present a case of total bilateral jaw necrosis in a patient with primary breast cancer and bone metastases treated with zeledronic acid and discuss the adverse effects of biphosphonates and the best moment to perform dental procedures. Case description: A female patient, 62 years old, with primary breast adenocarcinoma underwent chemotherapy and zoledronic acid because of bone metastases on the right hip. After 7 months, she was submitted to debridement of exposed bone on the anterior mandible, which resulted in skin fistulae and severe pain. Computerized tomography showed bone sequestration hypodensity at the right and left mandibular body and mentum with excessive uptake of the labeled drug as seen by bone scintigraphy. The patient received amoxicillin, gluconate and chlorhexidine mouthrinse and hydrogen peroxide; partial closure of skin fistulae was achieved. After 4 months, the patient returned with submandibular tissue necrosis, intra- and extra-orally exposed mandible with active discharge. After 5 days of palliative treatment, the patient died from sepsis. Conclusion: Local infection/inflammation should be treated before the use of biphosphonates, and topic and systemic pharmacologic treatment should be combined with a strict follow-up. For selected cases, the osteonecrosis treatment may include conservative debridement, pain control, topic and systemic antimicrobial control, and, in extremely severe cases, radical surgery.Objetivo: Apresentar um caso de necrose total de mandíbula, bilateral, em uma paciente com neoplasia primária de mama e metástases ósseas tratadas com ácido zoledrônico endovenoso, e discutir os efeitos adversos de bisfosfonatos e o momento adequado para realização de procedimentos odontológicos. Descrição do caso: Paciente do sexo feminino, 62 anos, com adenocarcinoma de mama primário foi submetida a quimioterapia e uso de ácido zoledrônico devido a metástases ósseas no quadril direito. Após 7 meses, realizou-se debridamento de osso exposto na região anterior da mandíbula, resultando em fístulas e dor severa. Os exames de tomografia computadorizada e de cintilografia óssea revelaram hipodensidade do sequestro ósseo no corpo mandibular e no mento com presença excessiva da droga nestes sítios. Após antibioticoterapia e uso de enxaguatórios bucais houve fechamento parcial das fístulas. Após 4 meses, a paciente retornou com necrose submandibular e osso mandibular exposto intra e extraoralmente com drenagem. Após 5 dias de tratamento paliativo a paciente morreu de sepsis. Conclusão: Focos de infecção e/ou processos inflamatórios locais devem ser tratados previamente ao uso de bisfosfonatos. Indica-se o tratamento farmacológico tópico e sistêmico, e a proservação do caso. Terapias para osteonecrose, em determinados casos, envolvem debridamento conservador, controle da dor, manejo antimicrobiano tópico e sistêmico e, em casos extremos, cirurgia radical.EDIPUCRS - Editora Universitária da PUCRS2009-07-17info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionPeer-reviewed Articlecase report; reviewapplication/pdfhttps://revistaseletronicas.pucrs.br/ojs/index.php/fo/article/view/4859Revista Odonto Ciência; Vol. 24 No. 4 (2009); 435 - 438Revista Odonto Ciência; v. 24 n. 4 (2009); 435 - 4381980-65230102-9460reponame:Revista odonto ciência (Online)instname:Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)instacron:PUC_RSenghttps://revistaseletronicas.pucrs.br/ojs/index.php/fo/article/view/4859/4789Martins, Gustavo LisboaPuricelli, Edelade Paris, Marcel FasoloPonzoni, DeiseBaraldi, Carlos Eduardo Espíndolainfo:eu-repo/semantics/openAccess2013-11-11T12:57:33Zoai:ojs.revistaseletronicas.pucrs.br:article/4859Revistahttps://revistaseletronicas.pucrs.br/ojs/index.php/foPRIhttps://revistaseletronicas.pucrs.br/ojs/index.php/fo/oai||odontociencia@pucrs.br1980-65230102-9460opendoar:2013-11-11T12:57:33Revista odonto ciência (Online) - Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)false |
dc.title.none.fl_str_mv |
Mandibular avascular osteonecrosis caused by bisphosphonate – a case report and brief review Osteonecrose avascular de mandíbula por uso de bisfosfonato – relato de caso e breve revisão |
title |
Mandibular avascular osteonecrosis caused by bisphosphonate – a case report and brief review |
spellingShingle |
Mandibular avascular osteonecrosis caused by bisphosphonate – a case report and brief review Martins, Gustavo Lisboa osteonecrosis biphosphonates zoledronic acid Oncology |
title_short |
Mandibular avascular osteonecrosis caused by bisphosphonate – a case report and brief review |
title_full |
Mandibular avascular osteonecrosis caused by bisphosphonate – a case report and brief review |
title_fullStr |
Mandibular avascular osteonecrosis caused by bisphosphonate – a case report and brief review |
title_full_unstemmed |
Mandibular avascular osteonecrosis caused by bisphosphonate – a case report and brief review |
title_sort |
Mandibular avascular osteonecrosis caused by bisphosphonate – a case report and brief review |
author |
Martins, Gustavo Lisboa |
author_facet |
Martins, Gustavo Lisboa Puricelli, Edela de Paris, Marcel Fasolo Ponzoni, Deise Baraldi, Carlos Eduardo Espíndola |
author_role |
author |
author2 |
Puricelli, Edela de Paris, Marcel Fasolo Ponzoni, Deise Baraldi, Carlos Eduardo Espíndola |
author2_role |
author author author author |
dc.contributor.author.fl_str_mv |
Martins, Gustavo Lisboa Puricelli, Edela de Paris, Marcel Fasolo Ponzoni, Deise Baraldi, Carlos Eduardo Espíndola |
dc.subject.por.fl_str_mv |
osteonecrosis biphosphonates zoledronic acid Oncology |
topic |
osteonecrosis biphosphonates zoledronic acid Oncology |
description |
Purpose: To present a case of total bilateral jaw necrosis in a patient with primary breast cancer and bone metastases treated with zeledronic acid and discuss the adverse effects of biphosphonates and the best moment to perform dental procedures. Case description: A female patient, 62 years old, with primary breast adenocarcinoma underwent chemotherapy and zoledronic acid because of bone metastases on the right hip. After 7 months, she was submitted to debridement of exposed bone on the anterior mandible, which resulted in skin fistulae and severe pain. Computerized tomography showed bone sequestration hypodensity at the right and left mandibular body and mentum with excessive uptake of the labeled drug as seen by bone scintigraphy. The patient received amoxicillin, gluconate and chlorhexidine mouthrinse and hydrogen peroxide; partial closure of skin fistulae was achieved. After 4 months, the patient returned with submandibular tissue necrosis, intra- and extra-orally exposed mandible with active discharge. After 5 days of palliative treatment, the patient died from sepsis. Conclusion: Local infection/inflammation should be treated before the use of biphosphonates, and topic and systemic pharmacologic treatment should be combined with a strict follow-up. For selected cases, the osteonecrosis treatment may include conservative debridement, pain control, topic and systemic antimicrobial control, and, in extremely severe cases, radical surgery. |
publishDate |
2009 |
dc.date.none.fl_str_mv |
2009-07-17 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Peer-reviewed Article case report; review |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://revistaseletronicas.pucrs.br/ojs/index.php/fo/article/view/4859 |
url |
https://revistaseletronicas.pucrs.br/ojs/index.php/fo/article/view/4859 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
https://revistaseletronicas.pucrs.br/ojs/index.php/fo/article/view/4859/4789 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
EDIPUCRS - Editora Universitária da PUCRS |
publisher.none.fl_str_mv |
EDIPUCRS - Editora Universitária da PUCRS |
dc.source.none.fl_str_mv |
Revista Odonto Ciência; Vol. 24 No. 4 (2009); 435 - 438 Revista Odonto Ciência; v. 24 n. 4 (2009); 435 - 438 1980-6523 0102-9460 reponame:Revista odonto ciência (Online) instname:Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) instacron:PUC_RS |
instname_str |
Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) |
instacron_str |
PUC_RS |
institution |
PUC_RS |
reponame_str |
Revista odonto ciência (Online) |
collection |
Revista odonto ciência (Online) |
repository.name.fl_str_mv |
Revista odonto ciência (Online) - Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) |
repository.mail.fl_str_mv |
||odontociencia@pucrs.br |
_version_ |
1754820874846863360 |