title: A case of nasal septal abscess caused by medication related osteonecrosis in breast cancer patient.
abstract: Antiresorptive drugs have been widely used to treat patients with hypercalcemia caused by malignancy, bone metastasis, multiple myeloma, and osteoporosis. However, it is well known that antiresorptive drugs can cause osteonecrosis of the jaw (ONJ). Herein, we report a rare case of nasal septal abscess caused by medication related osteonecrosis of the jaw (MRONJ) in a breast cancer patient. A 69-year-old woman was referred to our clinic for evaluation of nasal obstruction. Physical examination revealed a cherry-like swelling of the nasal mucosa emanating from the septum that obstructed both nasal cavities and a fistulous tract showing pus discharge after extraction of the bilateral maxillary central incisors (MCI) and the right maxillary lateral incisor (MLI). Computed tomography and panoramic radiography revealed extensive osteonecrosis of the maxilla and swelling of the nasal mucosa. The clinical diagnosis was nasal septal abscess caused by osteonecrosis of the maxilla. Surgical procedure was undertaken for this case. An indwelling drain was placed in the oral cavity, and sequestrectomy was performed with incision and drainage of the anterior portion of left nasal septum. The patient was doing well at the 7-month follow-up. The patient had a medical history of breast cancer with bone, lung, liver metastases, and had received intravenous bisphosphonate, which is one of the antiresorptive medicines, over the past 4 years. We suspect that this history played an important role in MRONJ induced nasal septal abscess.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, National Defense Medical Collage, Namiki 3-2, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Mayuka
authors.initials: M
authors.lastname: Maeda
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, National Defense Medical Collage, Namiki 3-2, Tokorozawa, Saitama 359-8513, Japan; Department of Otolaryngology, New Tokyo Hospital, Wanagaya 1271, Matsudo, Chiba, Japan. Electronic address: t-matsunobu@shin-tokyohospital.or.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsunobu
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, National Defense Medical Collage, Namiki 3-2, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Takaomi
authors.initials: T
authors.lastname: Kurioka
authors.affiliation: Department of Otolaryngology, Nisseki Hospital, Kamiochiai 8-3-33, Chuoku, Saitamashi, Saitama, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kurita
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, National Defense Medical Collage, Namiki 3-2, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Shiotani
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging / Q000209:etiology*; D000368:Aged; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000150:complications* / Q000000981:diagnostic imaging; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000556:secondary; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D003751:Dental Fistula / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006801:Humans; D008439:Maxillary Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D009300:Nasal Septum / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
chemical_list: D050071:Bone Density Conservation Agents
keywords: Bisphosphonate; MRONJ; Nasal septal abscess; Osteonecrosis