Revista nº 798

116

Paolo Cariati

Bilateral jaw fracture after long term treatment with bisphosphonates

intravenous antibiotic treatment was administered and a maxillo-

facial surgeon was contacted. A careful anamnesis revealed that

patient received long term therapy with bisphosphonates. In fact,

she was diagnosed with breast cancer eight years ago. Intraoral

examination showed bone exposure with active suppuration of

purulent matter in the third and fourth quadrants of the jaw. The

rest of the physical examination was normal. Bearing in mind the

patient’s history, we decided to perform an orthopantomography.

This test showed a major area of bone degeneration and a bilate-

ral non-displaced fracture of the mandible. Considering all this, the

patient was hospitalized in order to maintain intravenous antibio-

tic treatment. Treatment response was positive since the earliest

days. In view of that, we continue with this conservative approach

during ten days. We also perform a rigid blockage of the jaw and

a complete debridement of necrotic tissue. The clinic substantially

improve during the hospital stay. Finally, she was discharged from

hospital after two weeks with oral antibiotic for other four wee-

ks. Importantly, jaw blockage was also maintained during 4 weeks.

Patient was reviewed every 3-4 weeks for one year. It is important

to underline that during the follow-up, we observed that patient

remained asymptomatic.

DISCUSSION:

In recent times, the use of bisphosphonates is growing rapidly.

In fact, oral and intravenous preparations of this drugs are daily

prescribed for treating pathologies such as osteoporosis, rheumatic

pathologies and several metabolic bone diseases. In this light, the

main aim of the present report is to show the serious consequen-

ces that bisphosphonates could provoke on the jaw bone. In our

opinion, these complications are often underestimated by a vast

number of clinicians. This report raises three central points. First,

conservative treatment is preferable where possible in cases of

ONJ. In this line, unnecessary manipulation of the oral cavity should

be avoided in these patient. Second, an accurate oral examination

is mandatory before the beginning of bisphosphonate treatment.

In fact, the existence of dental pathology need to be diagnosed and

treated prior to commencement with antiresorptive medication.

This attitude might reduce the frequency of ONJ (10). Third, is the

consideration that bisphosphonates should be used with caution.

In fact, patients who receive bisphosphonates need a close moni-

toring for life. In addition, there are no effective treatments for this

disease.

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Fig 1. Bilateral jaw fracture.

Fig 2. Jaw fracture evolution during patient follow-up

(one months after diagnosis)

Fig 3. Jaw fracture evolution during patient follow-up (nine months

after fracture reduction)