Bisphosphonate related osteonecrosis of the jaw

Abstract

BRONJ is a rare condition tiiat occurs in patients treated witii intravenous bisphosphonates usually due to bone metastasis or conditions leading to hypercalcaemia. The purpose is to objectify the role of diagnostic imaging in detecting rare conditions. A case of a 40-year old female, who had undergone mastectomy of the left breast due to invasisce ductal carcinoma G3 nine years ago with bone and hepatic metastasis, followed by chemotherapy and radiotherapy and treatment with Zometa. The patient presented with repeated cases of inflammations of the lower jaw. Examination revealed facial asymmetry on the left due to well limited solid painful mass along the edge of lower jaw. CT scan of the head and cervical spine was performed on a 64 row MDCT with contrast enhancement. CT scan revealed a large osteonecrotic area of the lower jaw on the left side, with the presence of fragments extending from tooth 35 until the angle of the mandible. Medial and lateral to the defect a soft tissue mass was found. BRONJ is a rare condition. The role of diagnostic imaging in BRONJ cases can be used in early detecting the condition as well as in therapeutic way to plan the right treatment.