Abstract
We report an advanced case of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in an osteoporotic patient treated with oral risedronate sodium for 2 years. An 80-year-old woman presented to our hospital complaining of pain, swelling and pus discharge in the lower alveolar ridge. Fluorine-18 labeled fluorodeoxyglucose positron emission tomography (FDG-PET) and bone scintigraphy showed definite uptake in the mandible. Under clinical diagnosis of BRONJ, we applied systematic treatments including antibiotic therapy, irrigation, cessation of bisphosphonate, hyperbaric oxygen (HBO) therapy, and debridement of necrotic bone. After pre-operative 20 sessions of HBO therapy, her clinical symptoms disappeared. SUVmax of FDG-PET decreased definitely from 4.5 to 2.5, although magnetic resonance image and bone scintigraphy did not show remarkable changes. After minor surgery with debridement of necrotic bone, she received another ten sessions of HBO therapy. After the treatment, her clinical course was excellent. In conclusion, this report demonstrates FDG-PET may predict the effect of HBO therapy in BRONJ.
References
Nastro E, Musolino C, Allegra A, Oteri G, Cicciù M, Alonci A, Quartarone E, Alati C, De Ponte FS. Bisphosphonate-associated osteonecrosis of the jaw in patients with multiple myeloma and breast cancer. Acta Haematol. 2007;117:181–7.
Marx RE. Pamidronate (Aredia) and zoledronate (Zometa induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg. 2003;61:1115–7.
Berenson JR, Hillner BE, Kyle RA, Anderson K, Lipton A, Yee GC, Biermann JS. American Society of Clinical Oncology clinical practice guidelines: the role of bisphosphonates in multiple myeloma. J Clin Oncol. 2002;20:3719–36.
Advisory Task Force on Bisphosphonate-Related Ostenonecrosis of the Jaws, American Association of Oral and Maxillofacial Surgeons. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg. 2007;65:369–76.
Yamazaki Y, Kitagawa Y, Hata H, Abe T, Murai C, Shiga T, Tamaki N. Use of FDG PET to evaluate hyperbaric oxygen therapy for bisphosphonates-related osteonecrosis of the jaw. Clin Nucl Med. 2010;35:590–1.
Feldmeier JJ, Hampson NB. A systematic review of the literature reporting the application of hyperbaric oxygen prevention and treatment of delayed radiation injuries: an evidence based approach. Undersea Hyperb Med. 2002;29:4–30.
Freiberger JJ. Utility of hyperbaric oxygen in treatment of bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg. 2009;67:96–106.
Marx RE. A new concept in the treatment of osteoradionecrosis. J Oral Maxillofac Surg. 1983;41:351–3.
Boykin JV, Baylis C. Hyperbaric oxygen therapy mediates increased nitric oxide production associated with wound healing. A preliminary study. Adv Skin Wound Care. 2007;20:382–8.
Mignogna MD, Fedele S, Lo Russo L, et al. Case 2: osteonecrosis of the jaws associated with bisphosphonate therapy. J Clin Oncol. 2006; 24:1475–77.
Acknowledgments
The authors are grateful to all staff who belong to the Department of Oral Diagnosis and Medicine and the Department of Nuclear Medicine, Hokkaido University.
Conflict of interest
No potential conflicts of interest were disclosed.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fatema, C.N., Sato, J., Yamazaki, Y. et al. FDG-PET may predict the effectiveness of hyperbaric oxygen therapy in a patient with bisphosphonate-related osteonecrosis of the jaw: report of a case. Odontology 103, 105–108 (2015). https://doi.org/10.1007/s10266-013-0129-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10266-013-0129-y