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Revista de la Sociedad Española del Dolor

versão impressa ISSN 1134-8046


JUAREZ REBOLLAR, AG; COLIN ORDAZ, A  e  JUAREZ REBOLLAR, D. Pharmacological osteonecrosis in maxillofacial surgery, period 2013-2019. Rev. Soc. Esp. Dolor [online]. 2021, vol.28, n.4, pp.211-218.  Epub 08-Nov-2021. ISSN 1134-8046.


The word osteonecrosis (ONC) means "dead bone"; it is a bone disease secondary to the loss of blood supply to the bone, causing its collapse and subsequent death. It can occur in any bone in the body, including those of the maxillofacial region, it is more common in the jaw. In recent years, the relationship of ONC with drugs such as bisphosphonates, antiresorptive, steroids for prolonged use, angiogenesis inhibitor agents, among others, has been found. However, despite the studies carried out by various authors, ONC continues to be an underdiagnosed entity with variable management and treatment, which is why the inte­rest of this research arises with the main objective of reporting the cases of patients diagnosed with Pharmacological ONC.

Material and method:

A descriptive, retrospective, cross-sectional, observational study was carried out for approximately 6 years (January 1, 2013 - December 31, 2019), in the Maxillofacial Surgery service of the Specialty Hospital, of National Medical Center, "Siglo XXI", IMSS. Making a review of clinical records, collecting clinical and image controls, reporting the number of cases and the management of patients with ONC, as well as the number of cases of ONC that were related to drugs. Of 9 patients with a diagnosis of osteonecrosis (ONC), only 4 patients were Pharmacological ONC, from the Maxillofacial Surgery service.


From a universe of 9 patients with ONC, 4 representative cases of patients with pharmacological ONC were presented, with management based on the protocol used in the Maxillofacial Surgery service of the National Medical Center "Siglo XXI", IMSS; Likewise, the signs and symptoms with which the treatment was staged and determined are shown. The pharmacological treatment associated with ONC was: in 3 patients bisphosphonates (zoledronic acid) and only one patient with Denosumab. The most frequently affected site was the mandible and only one case was bimaxillary (maxilla and mandible). The treatment used as stipulated according to the case, in two ways: conservative and surgical, in both cases a 0.12 % chlorhexidine-based mouthwash was added, and only in case of the presence of infection amoxicillin-based antibiotic with clavulanic acid was given.


The present study was carried out only in the Maxillofacial Surgery service of the National Medical Center, "Siglo XXI", IMSS. The stages were differentiated according to the AAOMS, SICMF, and SIPMO, clinically imaging. The importance of carrying out a study exclusively of the Maxillofacial Surgery service will allow providing more specific information on the area to later study ONC jointly and in a multidisciplinary way, to later carry out more extensive reports of pharmacological osteonecrosis and/or bisphosphonates, in addition to later elaborating multicenter studies.

Palavras-chave : Osteonecrosis; pharmacological; bisphosphonates; denosumab.

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