Sunitinib related osteonecrosis of jaw: a case report.
A 58-year-old woman presented to the Oral and Maxillofacial Surgery Clinic experiencing severe limited mouth opening and exposed bone in the socket of the right mandibular third molar 8 months following the extraction of the tooth. The patient had been treated during the year before her presentation with sunitinib, an antiangiogenic drug, for renal cell carcinoma. The clinical, radiographic, and histologic picture of a chronic nonhealing extraction socket was consistent with osteonecrosis of the jaw (ONJ), although she had never been treated with bisphosphonates or corticosteroids. The treatment with sunitinib was discontinued and the patient was treated with antibiotics and physiotherapy for 12 weeks with complete recovery. Sunitinib may cause osteonecrosis of the jaw after oral surgical interventions with no previous exposure to bisphosphonates. The pathogenesis may be related to its antiangiogenic mechanism and impaired wound healing. Full recovery may require long-term cessation of the insulting drug combined with prolonged antibiotic treatment.
Department of Oral and Maxillofacial Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. yoram77@gmail.com
Yoram
Y
Fleissig
Eran
E
Regev
Hadas
H
Lehman
D000190:Actinomyces / Q000302:isolation & purification; D000196:Actinomycosis / Q000188:drug therapy; D000658:Amoxicillin / Q000627:therapeutic use; D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy; D019818:Clavulanic Acid / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007211:Indoles / Q000009:adverse effects*; D007680:Kidney Neoplasms / Q000188:drug therapy; D008334:Mandible / Q000098:blood supply / Q000601:surgery*; D008336:Mandibular Diseases / Q000139:chemically induced* / Q000188:drug therapy / Q000382:microbiology; D008875:Middle Aged; D008964:Molar, Third / Q000601:surgery; D010020:Osteonecrosis / Q000139:chemically induced* / Q000188:drug therapy / Q000382:microbiology; D011758:Pyrroles / Q000009:adverse effects*; D000077210:Sunitinib; D014081:Tooth Extraction / Q000009:adverse effects; D020390:Tooth Socket / Q000473:pathology
D020533:Angiogenesis Inhibitors; D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; D019818:Clavulanic Acid; D000658:Amoxicillin; D000077210:Sunitinib