REFRACTORY OSTEORADIONECROSIS IN PATIENT WITH CONCOMITANT USE OF ANTIRESORPTIVE DRUGS: A CASE REPORT

Some patients with head and neck cancer who undergo radiotherapy may be treated with antiresorptive drugs(bisphosphonates) concurrently. In this way, these patients could be more susceptible to a new type of osteonecrosis of the gnathic bones. This possible synergism of both treatments could generate a new clinical picture condition. A 65-year-old Brazilian woman was submitted to radiotherapy with diagnosis of oral squamous cell carcinoma of the tongue and underwent pharmacologic treatment with bisphosphonates during 5 months. At the beginning, after irradiation she developed osteoradionecrosis in the right mandible, which had been placed an implant, and for this reason was submitted to hyperbaric oxygen treatment. Moreover, in our clinical attendance she underwent conservative treatment with pentoxifylline and tocopherol, showing improvement of her condition. Currently, she is maintained with conservative approach and developed a pathologic fracture of right hemimandible; however, it was stabile between proximal and distal fracture regions.