Estilo et al.(11. Estilo CL, Fornier M, Farooki A, Carlson D, Bohle G 3rd, Huryn JM. Osteonecrosis of the jaw related to bevacizumab. J Clin Oncol. 2008;26(24):4037-8.) (United States) Case 1 |
Female, 51 |
Left mandible (lingual) |
EB (1x1mm), normal ST, no evidence of infection, discomfort |
NR |
Devitalized bone, bacteria (Actinomyces) and inflammatory cells |
Bevacizumab (inhibitor -VEGF), 15mg/kg, 3 weeks, total of 8 doses |
Dişel et al.(22. Dişel U, Beşen AA, Özyılkan Ö, Er E, Canpolat T. A case report of bevacizumab-related osteonecrosis of the jaw: old problem, new culprit. Oral Oncol. 2012; 48(2):e2-3.) (Turkey) |
Male, 51 |
Right mandible |
EB (3×3mm), ulcerated and necrotic ST, no evidence of infection, fistula and abscess, pain, difficulty masticating |
PR and CT: sclerotic bone lesion |
Osteonecrosis, bacteria (Actinomyces) |
Bevacizumab (inhibitor -VEGF) 5mg/kg, 6 cycles/2 weeks |
Brunamoti Binello et al.(33. Brunamonti Binello P, Bandelloni R, Labanca M, Buffoli B, Rezzani R, Rodella LF. Osteonecrosis of the jaws and bevacizumab therapy: a case report. Int J Immunopathol Pharmacol. 2012;25(3):789-91.) (Italy) |
Male, 47 |
Left mandible (lingual) |
EB, edema with moderate mucosal exudate, trismus, pain, left-sided lower lip paresthesia |
PR: no significant findings; CT: bone loss; BS: increased uptake |
NR |
Bevacizumab (inhibitor -VEGF),15mg/kg/ 6 months/8 doses |
Erovigni et al.(44. Erovigni F, Gambino A, Cabras M, Fasciolo A, Bianchi SD, Bellini E, et al. Delayed Diagnosis of Osteonecrosis of the Jaw (ONJ) Associated with Bevacizumab Therapy in Colorectal Cancer Patients: Report of Two Cases. Dent J (Basel). 2016;4(4):E39.) (Italy) Case 1 |
Male, 79 |
Left mandible (mylohyoid line) |
EB (3×1m), ulcerated and necrotic ST, fistula, asymptomatic |
CBCT: sclerotic lesion in the cortical bone, and alveolar residue with no sequestration images |
NR |
Bevacizumab (inhibitor-VEGF), dose NR |
Erovigni et al.(44. Erovigni F, Gambino A, Cabras M, Fasciolo A, Bianchi SD, Bellini E, et al. Delayed Diagnosis of Osteonecrosis of the Jaw (ONJ) Associated with Bevacizumab Therapy in Colorectal Cancer Patients: Report of Two Cases. Dent J (Basel). 2016;4(4):E39.) (Italy) Case 2 |
Male, 60 |
Left mandible (lingual) |
EB (1cm), pain and gingival lesion |
PR: no signs of osteolysis, only the alveolar profile; CT: 7mmx4mm cortical bone lesion |
NR |
Bevacizumab (inhibitor -VEGF), 5mg/kg/day/14 days (8 cycles/4 months) |
Ponzetti et al.(55. Ponzetti A, Pinta F, Spadi R, Mecca C, Fanchini L, Zanini M, et al. Jaw osteonecrosis associated with aflibercept, irinotecan and fluorouracil: attention to oral district. Tumori. 2016;102(Suppl 2):S74-7. Review.) (Italy) |
Female, 64 |
Right mandible |
Non-traumatic avulsion of two teeth with purulent secretion, symptoms NR |
PR and CT: multiple foci of osteonecrosis of the jaws |
NR |
Aflibercept (inhibitor -VEGF), dose NR |
Jung(66. Jung TY. Osteonecrosis of jaw after antiangiogenic agent administration in a renal cell carcinoma patient. Oral and Maxillofacial Surgery Cases. 2017; 3(2):27-33.) (Korea) |
Female, 62 |
Right and left mandible |
EB around implants on the right and left sides, with pus drainage, gingival bleeding and edema, pain |
PR and CT: fracture lines/bone sequestration in both regions; BS: bilateral uptake compatible with osteomyelitis |
Acute osteomyelitis |
Pazopanib (TKi), 6 months |
Pakosch et al.(88. Pakosch D, Papadimas D, Munding J, Kawa D, Kriwalsky MS. Osteonecrosis of the mandible due to anti-angiogenic agent, bevacizumab. Oral Maxillofac Surg. 2013;17(4):303-6.) (Germany) |
Female, 53 |
Left mandible (lingual) |
EB (15×3 mm), fistula due to B and L, inflamed and ulcerated ST, abscess, pain and edema |
PR and CBCT: osteolysis with two punctiform radiodense areas, due to foreign bodies, ST emphysema, fragmented cancellous bone, opacity of the right maxillary sinus |
Chronic osteomyelitis with bone marrow fibrosis and necrotic bone |
Bevacizumab (inhibitor -VEGF) and sorafenib (MKi), dose NR |
Greuter et al.(99. Greuter S, Schmid F, Ruhstaller T, Thuerlimann B. Bevacizumab-associated osteonecrosis of the jaw. Ann Oncol. 2008;19(12):2091-2.) (Switzerland) |
Female, 63 |
Left maxilla |
Fistula, pain, trigeminal neuralgia |
PR and CT: sinusitis and osteonecrosis |
Osteonecrosis |
Bevacizumab (inhibitor -VEGF), dose NR |
Serra et al.(1010. Serra E, Paolantonio M, Spoto G, Mastrangelo F, Tete S, Dolci M. Bevacizumab-related osteneocrosis of the jaw. Int J Immunopathol Pharmacol. 2009; 22(4):1121-3.) (Italy) |
Male, 64 |
Left mandible |
EB in the alveolar region, pain |
PR and CT: area of bone necrosis |
Necrotic bone, bacteria and inflammatory cells |
Bevacizumab (inhibitor -VEGF), 7.5mg/kg, 8g |
Koch et al.(1111. Koch FP, Walter C, Hansen T, Jager E, Wagner W. Osteonecrosis of the jaw related to sunitinib. Oral Maxillofac Surg. 2011;15(1):63-6.) (Sweden) |
Male, 59 |
Left mandible |
EB (10mm), normal ST, pain |
DVT: area of hypodense bone with no sequestration |
Necrotic bone, bacteria (Actinomyces) |
Sorafenib (TKi), sunitinib (TKi) 50mg/day |
Bettini et al.(1212. Bettini G, Blandamura S, Saia G, Bedogni A. Bevacizumab-related osteonecrosis of the mandible is a self-limiting disease process. BMJ Case Rep. 2012;2012. pii:bcr2012007284.) (Italy) |
Female, 57 |
Left mandible |
EB (6x3cm) reaching basal bone; severe periodontal disease, periodontal abscess in the right posterior region, pain and halitosis |
BS: focal and persistent uptake suggestive of bone infection. CT: bone sequestration |
Osteonecrosis, inflammatory infiltrate and few blood vessels |
Bevacizumab (inhibitor -VEGF), 945mg IV/21 days |
Nicolatou-Galitis et al.(1313. Nicolatou-Galitis O, Migkou M, Psyrri A, Bamias A, Pectasides D, Economopoulos T, et al. Gingival bleeding and jaw bone necrosis in patients with metastatic renal cell carcinoma receiving sunitinib: report of 2 cases with clinical implications. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 113(2):234-8.) (Greece) Case 2 |
Female, 64 |
Left mandible (lingual) |
EB, inflamed ST, superior central incisors present with periodontal disease, pain |
PR: no obvious radiological changes or bone disease |
NR |
Sunitinib (TKi), 50mg/day |
Hopp et al.(1414. Hopp RN, Pucci J, Santos-Silva AR, Jorge J. Osteonecrosis after administration of intravitreous bevacizumab. J Oral Maxillofac Surg. 2012;70(3):632-5.) (Brazil) |
Male, 58 |
Left mandible (lingual) |
EB (5x5mm), normal ST, regional teeth with no pulp/periodontal abnormalities, pain |
EX: absence of periapical/periodontal problems |
Necrotic bone and bacteria |
Bevacizumab (inhibitor -VEGF), 2.5mg (intravitreal) |
Fleissig et al.(1515. Fleissig Y, Regev E, Lehman H. Sunitinib related osteonecrosis of jaw: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113(3):e1-3.) (Israel) |
Male, 58 |
Right mandible |
EB (small area), inflamed ST, limited pus drainage, enlarged submandibular lymph nodes; pain and limited mouth opening |
PR: incomplete bone remodeling in the alveolar region; CT: irregular alveolar cortical margin at 38 |
Necrotic bone and bacteria |
Sunitinib (TKi), 50mg, once a day/4 consecutive weeks followed by 2 weeks off drugs |
Magremanne et al.(1616. Magremanne M, Lahon M, De Ceulaer J, Reychler H. Unusual bevacizumab-related complication of an oral infection. J Oral Maxillofac Surg. 2013;71(1): 53-5) (Belgium) |
Male, 49 |
Left mandible |
EB from the angle to the midline of the mandible, submandibular edema reaching the clavicle, partial necrosis of the mental nerve and facial artery, pain |
PR: absence of periapical/periodontal lesions; CT: infiltration; ST, no evidence of necrosis |
Necrotic tissues, inflammatory infiltrate, hemorrhagic necrosis and local thrombosis |
Bevacizumab inhibitor -VEGF), 10mg/kg, single dose |
Santos-Silva et al.(1717. Santos-Silva AR, Belizário GA, Castro Júnior GD, Dias RB, Prado Ribeiro AC, Brandão TB. Osteonecrosis of the mandible associated with bevacizumab therapy. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115(6):e32-6.) (Brazil) |
Male, 61 |
Left mandible (lingual) |
EB (1x1cm), normal ST, pain |
PR: area of destroyed bone with discontinuity of the external oblique line; CT: lesion-associated loss of integrity and erosion of the underlying cortical bone |
NR |
Bevacizumab(inhibitor -VEGF) IV (10mg/kg every other week) |
Marino et al.(1818. Marino R, Orlandi F, Arecco F, Gandolfo S, Pentenero M. Osteonecrosis of the jaw in a patient receiving cabozantinib. Aust Dent J. 2015;60(4):528-31.) (Italy) |
Female, 51 |
Left mandible |
Inflammation, infection with pus drainage, asymptomatic |
PR: incomplete bone remodeling; CT: cortical irregularity and sclerotic reaction |
Atypical bone necrosis |
Cabozantinib (TKi), 175mg/day |
Garuti et al.(1919. Garuti F, Camelli V, Spinardi L, Bucci L, Trevisani F. Osteonecrosis of the jaw during sorafenib therapy for hepatocellular carcinoma. Tumori. 2016; 102(Suppl 2):S69-70.) (Italy) |
Male, 74 |
Right mandible (body region) |
EB with no infection/sequestration, gingival lesion |
CBCT: lytic area in the contralateral mandibular body (right side), at the site of prior tooth extraction (October 2014) |
NR |
Sorafenib (TKi), 400mg/day |