Bisphosphonate‐related osteonecrosis of the skull base

Abstract

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is reported in up to 18.6% of patients treated with intravenous bisphosphonates and can result in significant morbidity. Most cases are managed by oral surgeons with only a handful of reports appearing in the otolaryngology literature. We present a unique case of extensive BRONJ involving the maxilla, sinuses, and skull base, complicated by sinusitis and an intracranial abscess. This is the first description of BRONJ involving the skull base. The pathogenesis and management of this process are reviewed.

Medication‐related osteonecrosis of the posterior maxilla: surgical treatment using a combined transnasal endoscopic and intraoral approach, our experience with seven consecutive patients

“…However, most of the studies on this topic failed to address a comprehensive treatment of the rhino‐sinus involvement in this pathology and the related complications. In fact, ONJ and the related sinusitis can lead to complications such as nasal septal abscess, orbital cellulitis, skull base osteonecrosis and eventually brain abscess. It must also be considered that patients affected by MRONJ are often suffering from other debilitating diseases.…”

Surgical treatment of medication‐related osteonecrosis of the upper jaw: Case series

“…Effective management of maxillary lesions is particularly important as the lesion can extend further and lead to nasal septal abscess, orbital cellulitis, skull base necrosis, and brain abscess (Khan & Sindwani, ; Maeda, Matsunobu, Kurioka, Kurita, & Shiotani, ; Malik, Fernando, Laitt, & Leatherbarrow, ; Matsushita, Kamigaki, & Nakamura, ; Yamada, Takahata, Nakagawa, Yamamoto, & Kogo, ). The same principles of treatment apply to maxillary and mandibular MRONJ, namely complete removal of non‐vital bone followed by meticulous wound closure.…”

Blindness resulting from bisphosphonate-related osteonecrosis of the skull base

“…Involvement of the skull base occurs in a rarity of cases. [15] BRONJ disproportionately affects the mandible; maxillary involvement occurs in approximately one-quarter to one-third of the cases. [2] When the maxilla is involved, 43-48% [16,17] progress to maxillary sinusitis, indicating Stage 3 disease: the most treatment-refractory stage of BRONJ.…”