Bisphosphonate-related osteonecrosis of the jaw in a patient with multiple myeloma

A 67-year-old female patient on ongoing treatment for multiple myeloma including pamidronate 90 mg intravenous, 1 injection per month, was referred for assessment of a mandibular lytic lesion. Surgical history included extraction of tooth #35. Intraoral examination revealed the presence of a sinus tract with active purulent discharge on a background of edematous hyperemic left buccal mucosa. Panoramic radiograph and cone beam computed tomography highlighted a radiopaque/hyperdense with radiolucent/hypodense rimming at the body of the mandible close to the left mental foramen. Based on the clinical and radiographic presentation, bisphosphonate-related osteonecrosis of the jaw was favored. Clindamycin (300 mg) 3 times a day for 15 days was prescribed and local debridement of the area was performed. Adequate bone remodeling was identified 6 months after the surgical procedure. The patient remains asymptomatic and under current clinical monitoring.