Osteonecrosis of mandible: A rare complication of long-term steroid use

Osteonecrosis of the jaw is defined as the presence of exposed bone in the maxillofacial region that does not heal within 8 weeks in the absence of radiation to the head and neck. Osteonecrosis of the jaw associated with long-term steroid use is a rare condition and has never been reported in the literature. We describe a 30-year-old female patient diagnosed with systemic lupus erythematosus (SLE) and on long-term steroid therapy that presented with nonhealing extraction socket of the lower left second premolar and the exposed bone from the lower left canine to molar regions for more than 8 weeks. Conservative management was initiated and later a sequestrectomy with primary closure under local anesthesia was performed. Although the lesion did not entirely resolve the patient remained asymptomatic for the following 2 years. Within the asymptomatic period, bisphosphonate was administered to control the bone porosity but later it aggravated the osteonecrosis. This case report highlights the possible risk of osteonecrosis of the jaw following the long-term steroid use and aggravation by bisphosphonate. (C) 2014 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI. Published by Elsevier Ltd. All rights reserved.