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Complications of new medications.

Roldan CJ, Paniagua L - West J Emerg Med (2014)

Bottom Line: We present the case of a woman with severe right-sided mandibular pain who was found to have a pathological fracture and osteonecrosis of the jaw (ONJ).The etiology of ONJ was found to be associated to previous use of zoledronic acid to treat osteoporosis.The aim of this case report is to discuss the etiology, diagnosis and treatment of ONJ secondary to the use of zoledronic acid and to outline a clinical condition rarely seen in the ED whose incidence might rise with the increasing use of bisphosphonates.

View Article: PubMed Central - PubMed

Affiliation: The University of Texas Health Science Center at Houston, Department of Emergency Medicine, Houston, Texas.

ABSTRACT
Numerous mandibular pathologies are diagnosed in the emergency department (ED). We present the case of a woman with severe right-sided mandibular pain who was found to have a pathological fracture and osteonecrosis of the jaw (ONJ). The etiology of ONJ was found to be associated to previous use of zoledronic acid to treat osteoporosis. The aim of this case report is to discuss the etiology, diagnosis and treatment of ONJ secondary to the use of zoledronic acid and to outline a clinical condition rarely seen in the ED whose incidence might rise with the increasing use of bisphosphonates.

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Related in: MedlinePlus

Computed tomography of the face without (A) and with (B) intravenous contrast. (A) Mandibular sclerosis with periosteal reaction of the mandibular body extending to the parasymphyseal region; given history of bisphosphonates therapy most likely osteonecrosis (full arrow). Diffuse subcutaneous edema and submental soft tissue swelling reflecting focal inflammatory changes (hollow arrow). (B) Osteoradionecrosis of the mandible with pathologic fracture of the right horizontal mandibular ramus (arrow).
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f1-wjem-16-154: Computed tomography of the face without (A) and with (B) intravenous contrast. (A) Mandibular sclerosis with periosteal reaction of the mandibular body extending to the parasymphyseal region; given history of bisphosphonates therapy most likely osteonecrosis (full arrow). Diffuse subcutaneous edema and submental soft tissue swelling reflecting focal inflammatory changes (hollow arrow). (B) Osteoradionecrosis of the mandible with pathologic fracture of the right horizontal mandibular ramus (arrow).

Mentions: A 73-year-old woman with history of hypertension and osteoporosis presented to a suburban emergency department (ED) complaining of right-sided mandibular pain and gum swelling for one week. She was diagnosed with gingivitis and discharged home on oral antibiotics, analgesics and a mouth rinse solution. She was advised to follow up with the dental service. After two weeks the symptoms continued to progress. She presented to our ED once the pain became unbearable after feeling a “pop” while trying to chew peanuts with the left side of her mouth. She denied malaise, fever, anorexia or any history of trauma. Our evaluation revealed a very uncomfortable-appearing female. She was afebrile (temperature 98.2°F) and had normal vital signs other than a blood pressure of 169/92mm Hg and heart rate 104 beats per minute. Her physical exam was remarkable for right mandibular edema, tenderness and crepitance to palpation. Her dentition was in fair condition and she had scattered fillings. A grayish discoloration of the gingiva was evident in the premolar zone with no apparent drainage. Laboratory values were within normal limits, including a white blood cell count of 8,000 cells/uL with 60% neutrophils. A computed tomography demonstrated “osteonecrosis of the jaw and a pathological fracture of the right ramus” (Figure). Further chart review established that the patient had been previously treated for osteoporosis with intravenous zoledronic acid once a year for two years. The most recent dose was one month earlier. The patient was hospitalized by ear nose throat surgery, and surgical reconstructive therapy was performed. Seven days later, her pain had nearly resolved and she was discharged home.


Complications of new medications.

Roldan CJ, Paniagua L - West J Emerg Med (2014)

Computed tomography of the face without (A) and with (B) intravenous contrast. (A) Mandibular sclerosis with periosteal reaction of the mandibular body extending to the parasymphyseal region; given history of bisphosphonates therapy most likely osteonecrosis (full arrow). Diffuse subcutaneous edema and submental soft tissue swelling reflecting focal inflammatory changes (hollow arrow). (B) Osteoradionecrosis of the mandible with pathologic fracture of the right horizontal mandibular ramus (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4307702&req=5

f1-wjem-16-154: Computed tomography of the face without (A) and with (B) intravenous contrast. (A) Mandibular sclerosis with periosteal reaction of the mandibular body extending to the parasymphyseal region; given history of bisphosphonates therapy most likely osteonecrosis (full arrow). Diffuse subcutaneous edema and submental soft tissue swelling reflecting focal inflammatory changes (hollow arrow). (B) Osteoradionecrosis of the mandible with pathologic fracture of the right horizontal mandibular ramus (arrow).
Mentions: A 73-year-old woman with history of hypertension and osteoporosis presented to a suburban emergency department (ED) complaining of right-sided mandibular pain and gum swelling for one week. She was diagnosed with gingivitis and discharged home on oral antibiotics, analgesics and a mouth rinse solution. She was advised to follow up with the dental service. After two weeks the symptoms continued to progress. She presented to our ED once the pain became unbearable after feeling a “pop” while trying to chew peanuts with the left side of her mouth. She denied malaise, fever, anorexia or any history of trauma. Our evaluation revealed a very uncomfortable-appearing female. She was afebrile (temperature 98.2°F) and had normal vital signs other than a blood pressure of 169/92mm Hg and heart rate 104 beats per minute. Her physical exam was remarkable for right mandibular edema, tenderness and crepitance to palpation. Her dentition was in fair condition and she had scattered fillings. A grayish discoloration of the gingiva was evident in the premolar zone with no apparent drainage. Laboratory values were within normal limits, including a white blood cell count of 8,000 cells/uL with 60% neutrophils. A computed tomography demonstrated “osteonecrosis of the jaw and a pathological fracture of the right ramus” (Figure). Further chart review established that the patient had been previously treated for osteoporosis with intravenous zoledronic acid once a year for two years. The most recent dose was one month earlier. The patient was hospitalized by ear nose throat surgery, and surgical reconstructive therapy was performed. Seven days later, her pain had nearly resolved and she was discharged home.

Bottom Line: We present the case of a woman with severe right-sided mandibular pain who was found to have a pathological fracture and osteonecrosis of the jaw (ONJ).The etiology of ONJ was found to be associated to previous use of zoledronic acid to treat osteoporosis.The aim of this case report is to discuss the etiology, diagnosis and treatment of ONJ secondary to the use of zoledronic acid and to outline a clinical condition rarely seen in the ED whose incidence might rise with the increasing use of bisphosphonates.

View Article: PubMed Central - PubMed

Affiliation: The University of Texas Health Science Center at Houston, Department of Emergency Medicine, Houston, Texas.

ABSTRACT
Numerous mandibular pathologies are diagnosed in the emergency department (ED). We present the case of a woman with severe right-sided mandibular pain who was found to have a pathological fracture and osteonecrosis of the jaw (ONJ). The etiology of ONJ was found to be associated to previous use of zoledronic acid to treat osteoporosis. The aim of this case report is to discuss the etiology, diagnosis and treatment of ONJ secondary to the use of zoledronic acid and to outline a clinical condition rarely seen in the ED whose incidence might rise with the increasing use of bisphosphonates.

Show MeSH
Related in: MedlinePlus