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A Journal on Maxillofacial Surgery

Official Journal of the Italian Society of Maxillofacial Surgery




Italian Journal of Maxillofacial Surgery 2014 December;25(2-3):65-8

language: English

Bisphosphonate-related osteonecrosis of the jaw: when surgery may be necessarys

Chiodi S. 1, Carta M. 1, Iacoviello P. 1, Signorini G. 1, Guglielmini P. 2, Fusco V. 2, Grosso F. 2, Piovano P. L. 2, Verrina G. 1

1 Unit of Maxillofacial Surgery, Ente Ospedaliero Ospedali Galliera, Genova, Italy;
2 Unit of Medical Oncology, Azienda Ospedaliera Nazionale “SS. Antonio e Biagio e C. Arrigo”, Alessandria, Italy


Osteonecrosis of the jaw (ONJ) is a rare adverse event of treatment with nitrogen-containing bisphosphonates (N-BPs) in metastatic cancer patients, which can negatively affect the patient’s quality of life and its management is still difficult. We here report the case of a patient with metastatic breast cancer who had been treated for many years with zoledronic acid ending in ONJ. The patient was referred to our Centre for an ascessual lesion with orocutaneous fistula, along with pain and inability to swallow, unresponsive to antibiotic therapy and surgical debridements. She underwent a left subtotal hemimandibulectomy with reconstruction. After surgery the pain disappeared and re-alimentation was achieved. The case points out that, in truly advanced ONJ, only a demolitive surgical approach can be effective.

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