Maxilary Suppurative Inflammation on Chronic Treatment with Bisphosphonates for Bone Metastasis – A Case Report

Introduction. Bisphosphonates represent a class of anti-resorbable bone care drugs that inhibit the function of active osteoclasts and reduce bone resorption. They are used in the Oncology and Hematology specialties as adjuvants in the treatment of osteolytic bone metastases and associate osteonecrosis of the maxillo-facial bones, most commonly of the mandible, as an adverse reaction. Material and method: case report. We present the case of a 65-years-old female patient, with breast cancer and bone metastasis, under chronic treatment with bisphosphonates. She presented a chronically odontogenic suppurative maxillary rhinosinusitis induced by maxillary post-extraction osteonecrosis on the background of bisphosphonate treatment and fistula in the upper right vestibule. Surgery under general anesthesia and sequestrectomy were performed. Discussion. The patient also associated coagulation disorders with mixed mechanism, adding an element of major surgical difficulty requiring a massive intraoperative transfusion with fresh refrigerated plasma to control hemostasis. Conclusions: The side effects of bisphosphonates used in the treatment of bone metastasis on the maxillofacial bones are significant. For this reason, the dental extraction in patients treated with bisphosphonates should be done with great caution and maxillary suppurative inflammation in post-extraction context in these patients should raise the suspicion of underlying bone necrosis.