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Table 1: Patient data
Patient Age, years Sex Underlying Condition Presentation Location Bisphosphonate Biopsy Management
1 65 F Multiple myeloma Nonhealing extraction socket/necrotic bone Left maxilla Zoledronate Necrotic bone Curettage, antibiotics, hyperbaric oxygen therapy
2 67 F Metastatic breast cancer Pain; nonhealing extraction socket Right posterior mandible Pamidronate changed to zoledronate Not done Analgesia; antibiotics
3 60 F Metastatic breast cancer Nonhealing extraction site; later complicated by infection and fistula formation Left posterior mandible, third molar Pamidronate Chronic osteomyelitis Curettage; antibiotic therapy
4 77 F Multiple myeloma Multifocal exposed bone Bilateral body and symphysis of mandible Pamidronate changed to zoledronate Osteonecrosis, extensive bacterial and inflammatory cell infiltration (Fig 5C) Mouth wash, antibiotics, surgical debridement
5 64 M Multiple myeloma Chronic nasal infection/sinusitis; pain Central maxilla Clodronate and pamidronate in the past Not done Long-term antibiotics
6 61 M Metastatic prostate cancer Painful bone exposure; subsequent loosening of teeth and spontaneous sequestration of the left mandible Bilateral mandibular bodies Zoledronate Not done Mouth rinses, antibiotics; filing of sharp bone spicule; removal of sequestra; extraction of tooth
7 75 F Metastatic breast cancer Infection, subcutaneous fistula; painful bone exposure Initially anterior mandible, subsequently bilateral mandibular bodies Zoledronate Active osteomyelitis IV antibiotics, then oral; marginal mandibulectomy
8 52 F Metastatic breast cancer Nonhealing extraction socket; painful bone exposure First left mandibular molar Zoledronate Sequestrum and chronically inflamed mucosa Mouth rinses; antibiotics; analgesia; debridement of extraction site
9 79 M Metastatic prostate cancer Infection; pain Right posterior mandible Alendronate changed to an injectable bisphosphonate Not done Antibiotics; mouth rinses
10 54 F Metastatic breast cancer Pain Anterior mandible Zoledronate Not done None
11 82 F Osteoporosis Nonhealing extraction socket Left maxilla Alendronate Necrotic bone coated with bacterial colonies Antibiotics, debridement
12 70 F Osteoporosis Nonhealing extraction socket Right posterior mandible Alendronate Not done Curettage, antibiotics
13 85 F Osteoporosis Nonhealing extraction socket; infection Left posterior mandible Alendronate Necrotic bone coated with bacteria Curettage, antibiotics
14 74 M Osteoporosis Infected exposed bone; pain Right posterior body of mandible Alendronate Not done Antibiotics, mouth washes, incision and drainage
15 54 F Metastatic breast cancer Pain, swelling, exposed bone, loose teeth; palatonasal and palatoantral fistula, sinusitis Maxilla, bilateral Zoledronate, alendronate, and pamidronate in the past Osteonecrosis and acute osteomyelitis, abundant bacteria associated with bone infiltration Multiple dental extractions, bilateral subtotal maxillectomy; antibiotics
Note:—M indicates male; F, female.