Journal of the Louisiana State Medical Society
in HBO-treated patients, a faster decrease in pain score, and no decrease in quality of life scores when compared to the control group. 14 Low-level laser therapy may be used to remove dead tissue and improve the reparative process. 4 A thorough microscopic examination of surgically re- moved tissue is necessary to confirm the diagnosis. Patients are often placed on BPs for metastatic disease, which, when affecting the mouth, can present with symptoms similar to BRONJ. Therefore, metastatic disease should be consid- ered in the differential diagnosis, 15 and the latter excluded on debrided bone and soft tissue. There were no signs of metastatic disease on microscopic examination of bone tis- sue from our patient. Hence, the diagnosis was confirmed as BRONJ. A point of interest in this case is its overlapping AAOMS criteria, including absence of ulceration and con- comitant infection, as observed in the biopsy REFERENCES 1. American Association of Oral andMaxillofacial Surgeons Position Paper on Bisphosphonate-Related Osteonecrosis of Jaws. J Oral Maxillofac Surg 2007; 65:369-376. 2. Russell RG. Biphosphonates: The first 40 years. Bone 2011; 49(1):2- 19. 3. Marx RE. Pamidronate (Aredia) and Zoledronate (Zometa) induced avascular necrosis of the jaws. A growing epidemic. J Oral Maxillofac Surg 2003; 61:115-118. 4. Petcu et al. Bisphosphonate-related osteonecrosis of jaw: an anti- angiogenic side-effect? Diagnostic Pathology 2012; 7:78 5. Wehrhan F, Stockmann P, Nkenke E, et al. Differential impairment of vascularization and angiogenesis in biphosphonate-associated osteonecrosis of the jaw-related mucoperiosteal tissue. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 112(2):216-221. 6. Vescovi P, Merigo E, Meleti M, et al. Bisphosphonate-related osteonecrosis of the jaws: a concise review of the literature and a report of a single-centre experience with 151 patients. Journal of Oral Pathology and Medicine 2012; 41:214-221. 7. Favus MJ. Diabetes and the risk of osteonecrosis of the jaw. J Clin Endocrinol Metab 2007; 92:817-818. 8. Woo SB, Hellstein JW, Kalmen JR. Systematic Review: Bisphosphonates and osteonecrosis of the jaws. Ann Intern Med 2006; 144:753-761. 9. Han ZH, Palnitkar S, Rao DS et al. Effects of ethnicity and age of menopause on the remodeling and turnover of the iliac bone: implications of mechanisms of bone loss. J Bone Miner Res 1997; 12:498-508. 10. FaviaG, Pilolli GP, Maiorano E. Histologic and histomorphometric features of bisphosphonate-related osteonecrosis of the jaw: An analysis of 31 cases with confocal laser scanning microscopy. Bone 2009; 45:406-413 11. Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrota B. American Association of Oral and Maxillofacial Surgeons Position Paper on Biphosphonate –relatedOsteonecrosis of the Jaws-2009 Update. J Oral Maxillofac Surg 2009; 67:2-12, Suppl. 12. Edwards BJ, Gounder M, McKoy JM et al. Pharmacovigilance and reporting oversight inUS-FDA fast tract process: Bisphosphonates and osteonecrosis of the jaw. Lancet Oncol 2008; 9:1166-1172. 13. Moretti F, Pellicioni GA, Montebugnoli L, Marchetti C. A prospective clinical trial for assessing the efficacy of a minimally invasive protocol in patients with biphosphonate –associated osteonecrosis of the jaws. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 2011; 112: 777-782. 14. Freiberger JJ, Padilla-Burgos R, McGraw T, et al. What is the Role of Hyperbaric Oxygen in the Management of Biphosphonate- Related Osteonecrosis of the Jaw: ARandomized Controlled Trail of Hyperbaric Oxygen as an Adjunct to Surgery and antibiotics. J Oral Maxillofac Surg 2012; 70:1573-1583. 15. Poulias E, Melakopoulos I, Tosios K. Metastatic breast carcinoma in the mandible presenting as a periodontal abscess: a case report. Journal of Medical Case Reports 2011; 5:265.
Dr. Robichaux is a Medical Student, Dr. Ong is Assistant Clinical Professor of Pathology, Dr. Veillon is a Clinical Professor of Pathology, Dr. Patel is House Officer, and Dr. Cotelingam is Professor of Pathology at Louisiana State University Health Sciences Center in Shreveport.
202 J La State Med Soc VOL 166 September/October 2014
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