APDT associated with sequestrectomy in the treatment of osteonecrosis in cancer patients with metastasis: Case report. (September 2022)

• Record Type: Journal Article
• Authors: Pacheco, Juliano Abreu; Tholt, Beatriz; Veiga, Eugênia Velludo; Pretel, Hermes
• Is Part Of: International journal of surgery case reports. Volume 98(2022)
• Publication Date: 2022-09
• Subjects: Bisphosphonate-associated osteonecrosis of the jaw -- BRONJ -- Surgery -- Oral -- Photodynamic therapy -- Lasers -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2022.107487
• Languages: English
• ISSNs: 2210-2612

Abstract

Abstract: Introduction and importance: Bisphosphonates are drugs that have demonstrated effectiveness in the prevention and treatment of bone metastases from malignant neoplasms and other diseases of bone metabolism and although they represent a risk factor for osteonecrosis. Presentation of case: The present case depicts a patient with prostate neoplasia and metastases, referred to the dental department because he presented severe periodontal infection in the previous incisors of the mandible and was under treatment by intravenous zoledronic acid. A panoramic x-ray showed a marked bone loss with a periodontal infection that indicated the tooth exodontia of the affected teeth. However, 2 months after the removal of the dental elements, bone sequestration was detected a CT scan confirmed that. Surgery was then performed to remove mandibular bone sequestration and photodynamic therapy (aPDT) treatment for decontamination of the affected area. Discussion: There was a tissue reconstitution of the site in 3 weeks and total eradication of bone necrosis with aPDT treatment associated with bone sequestration. Conclusion: aPDT has proven to be an effective complementary treatment for the process of tissue decontamination and photostimulation in cases of BRONJ. Highlights: Zoledronic acid, a bisphosphonate third generation, is 10, 000 times more potent than a first-generation Osteonecrosis associated with bisphosphonates. aPDT consists of the interaction of light with the photosensitizer that induce decontamination.