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Chirurgia 2014 April;27(2):109-13


language: English

Osteonecrosis of the maxilla with zygomatic bone exposure by zolendronic acid: a case report

Ferrara S. 1, Manfuso A. 1, Califano L. 1, Iaconetta G. 1, 2

1 Department of Oral and Maxillo Facial Surgery School of Medicine, Federico II University of Naples Naples, Italy; 2 Department of Neuro Surgery, School of Medicine, Federico II University of Naples, Naples, Italy


Bisphosphonates are a class of drugs extremely important in the treatment of several pathologies such as bony metastases, malignant hypercalcaemia, multiple myeloma, osteoporosis, and Paget’s disease. Since necrosis in the maxilla and jaw area is often associated to treatment with Bisphosphonates, the present study wants to assess any possible relation between Bisphosphonates therapy and osteonecrosis. Here, we report on a patient affected by multiple myeloma (MM) who developed necrosis of the maxilla and exposure of the zygomatic bone during bisphosphonates therapy (BT). In literature, to our knowledge no cases with so huge extension of necrosis have been reported to date. He refused any surgical treatment. After a 5-year follow-up, the disease is now well controlled without progression, with long term or intermittent courses of penicillin-type antibiotics. Bisphosphonates, such as pamidronate and zoledronate, play a determinant role in the treatment of several oncological diseases. Nevertheless, they could pose a risk for osteonecrosis in the maxilla and jaw region. Furthermore, the treatment of bisphosphonates-related osteonecrosis is still a challenge due to the extreme aggressiveness of the syndrome. Hence, the conservative or the aggressive approaches have to be carefully considered each time, case by case.

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