Tratamento cirúrgico de osteonecrose maxilar induzida pelo uso de bisfosfonatos: relato de caso

Abstract

Bisphosphonates represents a group of citotoxic drugs for osteoclasts which inhibit bone blood supply and are used in the treatment of bone and neoplastic diseases. These drugs may induce osteonecrosis of the jaws as a side effect, affecting directly the patient’s life quality. The purpose of this paper is to report a case of a male patient, 64 years old, with multiple myeloma and chronic periodontal disease, treated with intravenous zoledronic acid during two years. The patient has progressed with osteonecrosis in the right maxilla with asymptomatic bone exposure in the contiguous area of right first upper molar tooth, followed by lesion’s significant expansion involving the whole right side of the maxilla’s posterior region. After CT scans, suggestive areas of reactional osteitis and areas of bone discontinuity in the lateral wall and floor of the right maxillary sinus could be observed, and a surgical procedure involving an extensive sequestrectomy with the purpose of necrotic tissue’s debridement was indicated. Suture of the surgical wound has been performed and the buccal fat pad flap utilized in order to cover the exposed area, resulting in primary wound closure.