ONC Questions with correct answers

A patient with known multiple myeloma on zoledronic acid for hypercalcemia presents with: • Failure to heal at a site of recent dental extraction • Loosening of adjacent molars What is the diagnosis? - Answer Answer: Osteonecrosis of the jaw from chronic bisphosphonate use Remember the association between chronic use of bisphosphonates and development of osteonecrosis of the jaw (mandible and/or maxilla). The case could present loosening of teeth, soft tissue swelling, failure to heal after recent dental work, pain, and drainage. Cancers commonly associated are myeloma, prostate, and breast. The history of zoledronic acid use is key, but the case could also include pamidronate or oral bisphosphonates (alendronate, risedronate, ibandronate). Remember that patients on the IV drugs should not have dental extractions. A tobacco smoker presents with 2-month history of: • Dyspnea and cough • Facial swelling and a sensation of fullness of the head, especially when bending over • Distended neck and chest wall veins