Biphosphonate Related Osteonecrosis of the Maxilla: A Case Report

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a condition that occurs in the presence of exposed and necrotic bone in the maxillofacial region for more than 8 weeks in patients treated with antiangiogenic or antiresorptive drugs without a history of radiotherapy. This case report aims to present the management of maxillary jaw osteonecrosis caused by tooth extraction in a patient using IV (intravenous) bisphosphonates following surgical removal of the necrotic lesion supported with the use of oral pentoxifylline and alpha tocopherol. An 80-year-old female patient has been using IV bisphosphonates (zoledronic acid, ibandronic acid, alendronate sodium) regularly for osteoporosis diagnosed in 2011. The patient applied to the Oral and Maxillofacial Surgery Clinic of Akdeniz University Faculty of Dentistry in 2021 due to osteonecrosis in the left maxilla, which developed after extraction of tooth number 23 at a different center. Pentoxifylline and alpha tocopherol treatment was started and continued for 2 months preoperatively. Following the use of the drug, extensive resection including areas of necrosis was performed and improvement together with resolution of symptoms were observed. Medical treatment with Pentoxifylline and alpha tocopherol is an effective supportive option for the management of maxillary MRONJ.

Keywords

• Pentoxifylline
• Alpha-tocopherol
• MRONJ

Bifosfonat Kullanımına Bağlı Maksillada Osteonekroz: Bir Olgu Sunumu

Öz

Medikasyon ile ilişkili çene osteonekrozu (MRONJ); radyoterapi hikayesi olmayan, antianjiogenik veya antirezorptif ilaç kullanan hastalarda maksillofasiyal bölgede 8 haftadan uzun süre var olan ekspoze ve nekrotik kemik varlığında ortaya çıkan durumdur. Bu vaka raporunda; IV (intravenöz) bifosfonat kullanan hastada diş çekimine bağlı oluşan maksiller çene osteonekrozunun oral pentoksifilin ve alfa tokoferol kullanımını takiben nekroz alanının cerrahi olarak çıkartılması sonrası oluşan iyileşmeyi göstermek amaçlanmaktadır. 80 yaşındaki kadın hasta 2011 yılında tanısı konulan osteoporozdan dolayı aynı yıldan itibaren düzenli olarak IV bifosfonat (zoledronik asit, ibandronik asit, alendronat sodyum) kullanmaktadır. 2021 yılında dış merkezde çektirdiği 23 numaralı dişe bağlı olarak gelişen sol üst çenedeki osteonekroz nedeniyle 2021 yılında Akdeniz Üniversitesi Diş Hekimliği Fakültesi Ağız Diş ve Çene Cerrahisi kliniğine başvurmuştur. Hastaya 2 ay süre boyunca pentoksifilin ve alfa tokoferol medikal tedavisi uygulandı. İlaç kullanımını takiben nekroz alanları içeren geniş rezeksiyon yapılıp iyileşme sağlandı. Pentoksifilin ve alfa tokoferol medikal tedavisi, MRONJ tedavisinde etkin bir destek yaklaşımdır.

Anahtar Kelimeler

• Pentoksifilin
• Alfa Tokoferol
• MRONJ

Kaynakça

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