Lethal cervical abscess following bisphosphonate related osteonecrosis of the jaw

• Published in: Journal of cranio-maxillo-facial surgery 2014-10, Vol.42 (7), p.1203-1206
• Main Authors: Kaehling, Ch, Streckbein, Ph, Schmermund, D, Henrich, M, Burchert, D, Gattenloehner, S, Howaldt, H.-P, Wilbrand, J.-F
• Format: Article
• Language: English
• Subjects: Abscess - etiology; Alendronate - adverse effects; Bacterial embolism; Bisphosphonate; Bisphosphonate-Associated Osteonecrosis of the Jaw - complications; Bone Density Conservation Agents - adverse effects; BRONJ; Dentistry; Fatal Outcome; Female; Follow-Up Studies; Humans; Jugular Veins - microbiology; Lethal cervical abscess; Mandibular Diseases - complications; Middle Aged; Multiple Organ Failure - microbiology; Neck - pathology; Osteonecrosis; Shock, Septic - microbiology; Surgery; Venous Thromboembolism - microbiology
• ISSN: 1010-5182; 1878-4119
• DOI: 10.1016/j.jcms.2014.02.009

Abstract Context Bisphosphonates are common drugs used in the management of bone metabolic diseases. Because of their recently increased use, their adverse effects, especially bisphosphonate-related osteonecrosis of the jaw (BRONJ), are monitored more frequently. BRONJ is a critical challenge in craniofacial surgery and is difficult to treat. Its occurrence is either spontaneous or follows dentoalveolar surgery. Typical complications of BRONJ are painful exposed bone, pathological fractures, extra-oral fistula, and local infections. Objective The aim of this paper is to report a rare case of bacterial embolism in the internal jugular vein after a BRONJ-induced submandibular abscess resulting in bacterial sepsis, multi-organ failure syndrome, and death. Case illustration A 59-year-old female patient developed severe BRONJ (stage II) with recurrent abscesses after oral osteoporosis therapy with alendronic acid. A subsequent submandibular abscess led to bacterial embolism of the left internal jugular vein, causing sepsis and death. Discussion Prevention, early detection and management of BRONJ remain a crucial challenge in craniofacial clinical practice. Despite several therapeutic approaches described in the current literature, none have undergone bedside application. Conclusion Considering this report of death after recurrent abscesses following BRONJ, the use of bisphosphonates should be carefully monitored in order to prevent such severe complications.