Relationships of opacification in the nasal sinuses, rhinosinusitis, and antiresorptive agent-related osteonecrosis of the jaw

Auris Nasus Larynx. 2020 Dec;47(6):996-1002. doi: 10.1016/j.anl.2020.05.013. Epub 2020 Jun 24.

Abstract

Objective: Bone turnover suppression agents are widely used for prophylaxis of bone metastases from cancer and osteoporosis; the occurrence of their side effect, antiresorptive agent-related osteonecrosis of the jaw (ARONJ), has been increasing. We investigated the relationships between opacification in the nasal sinuses, rhinosinusitis, and ARONJ based on data obtained from oral surgeons.

Methods: We examined 132 patients who had been clinically diagnosed with ARONJ based on clinical observations; all patients had undergone treatment at the Departments of Otorhinolaryngology and Oral Surgery. In 16 of the 132 patients, we confirmed a diagnosis of osteonecrosis of the upper jaw and the presence of ipsilateral opacification of the maxillary sinus. We analyzed the data of these 16 patients in detail.

Results: Five of the 16 patients had some nasal symptoms and had been diagnosed with rhinosinusitis. The opacification of the rhinosinuses improved, partially improved, and remained unchanged after treatment in 10, three, and two patients, respectively; notably, imaging assessment could not be conducted after treatment in one case.

Conclusions: Although there is no consensus regarding the treatment of sinusitis accompanying ARONJ, attempts to improve the causal foci and conservative treatment may offer favorable results; thorough investigation is necessary in refractory cases before determining the use of surgery.

Keywords: Antiresorptive agent-related osteonecrosis of the jaw; Antiresorptive inhibitor; Odontogenic rhinosinusitis; Rhinosinusitis; Treatment.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bisphosphonate-Associated Osteonecrosis of the Jaw / etiology
  • Bone Density Conservation Agents / adverse effects*
  • Denosumab / adverse effects*
  • Denosumab / therapeutic use
  • Diphosphonates / adverse effects*
  • Diphosphonates / therapeutic use
  • Female
  • Fluoroquinolones / therapeutic use
  • Humans
  • Jaw Diseases / chemically induced*
  • Male
  • Middle Aged
  • Osteonecrosis / chemically induced*
  • Paranasal Sinuses / diagnostic imaging
  • Paranasal Sinuses / pathology*
  • Rhinitis / etiology
  • Sinusitis / etiology*
  • Tomography, X-Ray Computed

Substances

  • Bone Density Conservation Agents
  • Diphosphonates
  • Fluoroquinolones
  • Denosumab
  • sitafloxacin