PubMed · 15772272
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Sibylle von Vietinghoff, Ute Kettritz, Wolfgang Flügel, Wolfgang Schneider, Ralph Kettritz. 2005. Lumpy jaw revisited.. https://doi.org/10.1093/ndt%2Fgfh627
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INTRODUCTION: Bisphosphonates have been recently associated with bone necrosis of jaws. PATIENTS AND METHOD: Five patients were treated, two males and three females. All patients received bisphophonates and chemotherapeutic agents, two for multiple myeloma and three for breast cancer with bone metastasis. Bisphophonates were discontinued. None of the patients had received radiotherapy to the head and neck. The localization was mandibular in four patients and the maxillary area in one with oro-antral fistula. Histological and microbiological studies were performed. RESULTS: Histopathology demonstrated osteonecrosis and ruled out detectable neoplastic disease of the jaws. Four biopsies showed Actinomycosis. Four patients underwent sequestrectomy, but the mucosa did not heal. DISCUSSION: Two mechanisms are involved: the antiangiogenic effect of bisphophonates has recently been described in vivo; as bone mineralization increases, accumulation of microdamage is observed in animals studies. Only the jaws are affected by bone necrosis, suggesting a possible trophism for bisphosphonate uptake? Other risks factors have been found: cancer, use of chemotherapeutic agents or corticosteroids, renal failure, Actinomycosis infection. The only effective treatment is dental prevention before starting treatment.
INTRODUCTION: Maxillo-mandibular osteonecrosis is exceptional outside a context of cervico-facial radiotherapy. Bisphosphonates are non-metabolized pyrophosphate analogues which inhibit osteoclastic activity. Bisphosphonates are prescribed for the treatment of malignant hypercalcemia, osteolysis associated with metastatic bone disease, Paget's disease and osteoporosis. Maxillomandibular osteonecrosis with bisphosphonates can be observed in 1/10000 patients, but is probably underestimated due to lack of dental examination. MATERIAL AND METHODS: We describe six cases of mandibular necrosis associated with bisphosphonates: five of them as part of their treatment regimen for a neoplastic condition and one for osteoporosis. RESULTS: Two patients developed spontaneous bone necrosis. In two others, tooth extraction preceded the onset of osteonecrosis. In the last two patients, we noted a preexisting dental infection. All the histopathological examinations showed necrotic bone colonized by Actinomyces. DISCUSSION: Bisphosphonate-induced osteonecrosis is only found in the maxillomandibular area because the jaws are the only bone in the skeleton exposed to the external environment. The mandible is rendered particularly prone to necrosis even after minor trauma because of its terminal vascularization. Careful oral examination is recommended before prescribing bisphosphonate therapy.
Actinomycosis of the paranasal sinuses is a rare occurrence and its clinical presentation does not suggest a specific diagnosis. Therefore, actinomycosis should be included in the differential diagnosis of neoplasms and granulomatous lesions of the head and neck region. However, the differentiation from a malignant neoplasm is not easy because the radiological findings are frequently similar and positive cultures are difficult to obtain. This report highlights the clinical progress of paranasal actinomycosis associated with some computed tomography findings that can be extremely helpful in the correct diagnosis. The characteristics of the disease are described and the relevant literature is discussed.