title: Involvement of the maxillary sinus in bisphosphonate-related osteonecrosis of the jaw: Radiologic aspects.
abstract: BACKGROUND
  The use of bisphosphonates is very common among patients with osteoporosis and multiple myeloma as well as those with bone metastases from various malignancies. The benefits of bisphosphonates are well recognized, but it became evident during the past decade that these medications portend the major adverse effect of osteonecrosis of the jaw, known as bisphosphonate-related osteonecrosis of the jaw.
  
  
  OBJECTIVE
  Our aim was to evaluate the specific manifestations of bisphosphonate use on the maxillary sinus in patients with documented bisphosphonate-related osteonecrosis of the jaw.
  
  
  METHODS
  A retrospective review of all the patients diagnosed between October 2003 to August 2014 as having bisphosphonate-related osteonecrosis of the jaw in a large university-affiliated tertiary care medical center. The records of 173 patients diagnosed as having bisphosphonate-related osteonecrosis of the jaw during the study period were retrieved. The available head and neck computed tomographic images were analyzed for cases of involvement of the maxilla.
  
  
  METHODS
  Manifestations of bisphosphonate-related osteonecrosis of the jaw as observed on physical examination and on imaging studies.
  
  
  RESULTS
  Seventy-one patients (41%) had involvement of the maxilla, 86 patients (49%) had involvement of the mandible, and 16 patients (9%) had involvement of both the maxilla and the mandible. Computerized tomography studies were available for 50 patients with involvement of the maxilla: 36 (72%) had evidence of maxillary sinus opacification (in comparison, the incidence of maxillary sinus opacification as an incidental finding in the general population is reported to be 19%, p < 0.0001). Sixteen patients (32%) had evidence of oroantral fistula, and five patients (10%) had oronasal fistula.
  
  
  CONCLUSIONS
  In addition to its well-established effects on the mandible and maxilla, bisphosphonate-related osteonecrosis of the jaw significantly affected the maxillary sinus. Its radiologic manifestations should be recognized by clinicians and especially by otolaryngologists.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.
authors.forename: Oshri
authors.initials: O
authors.lastname: Wasserzug
authors.forename: Israel
authors.initials: I
authors.lastname: Kaffe
authors.forename: Towy Sorel
authors.initials: TS
authors.lastname: Lazarovici
authors.forename: Tal
authors.initials: T
authors.lastname: Weissman
authors.forename: Ran
authors.initials: R
authors.lastname: Yahalom
authors.forename: Dan M
authors.initials: DM
authors.lastname: Fliss
authors.forename: Noam
authors.initials: N
authors.lastname: Yarom
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000000981:diagnostic imaging*; D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy*; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008443:Maxillary Sinus / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates