Perimandibular abscess associated with bisphosphonate‐related osteonecrosis of the jaw

Abstract

Bisphosphonates are widely used for treatment of osteoporosis, metastatic bone cancer, multiple myeloma, osteogenesis imperfecta, and Paget disease, dispensed worldwide.1 Bisphosphonate‐related osteonecrosis of the jaw (BRONJ) potentially yield refractory jawbone infections. We describe two elderly cases of BRONJ‐associated perimandibular abscess, which resulted in decrease of activity of daily living. The first case was a 74‐year‐old man who received zoledronate for 8 years as treatment for metastatic prostate cancer. Left buccal and retropharyngeal abscesses developed 4 months after removal of his teeth (Figure 1A). The second case was a 97‐year‐old woman who continued taking alendronate for over 10 years. A left buccal abscess occurred 5 days after extracting her teeth (Figure 1B). Culture tests revealed the presence of Prevotella spp. in the former, and Streptococcus constellatus, Prevotella spp. in the second patient. In addition to drainage, antibiotic therapies were given more than 5 weeks in each case. Although the infections improved, their masticatory functions deteriorated and long‐term rehabilitations were necessary. Figure 1 Dental panoramic X‐ray and CT: (A) the first case, (B) the second case Complication of perimandibular abscess can be associated with BRONJ,2 which may eventually result in masticatory dysfunction. Elderly patients3 or those receiving long‐term (>4 years) bisphosphonate treatment4 are in higher risks for the occurrence of BRONJ. Clinicians should be aware that dental procedures precede the occurrence of BRONJ in patients administered with bisphosphonate). CONFLICT OF INTEREST The authors have stated explicitly that there are no conflicts of interest in connection with this article.