Uso do laser no tratamento de osteonecrose induzida por zometa em mandíbula: relato de caso

Abstract

INTRODUCTION: Bisphosphonates are drugs used by patients with breast and prostate cancer, or for the prevention and treatment of bone metastases. Osteonecrosis of the gnathic bones is one of the main complications of this drug use; it is difficult to treat and has a dubious prognosis. Photobiomodulation therapy (PBM) and photodynamic therapy (PDT) have been reported as adjuncts in the treatment of osteonecrosis, but there are few studies reporting the effectiveness of these therapies. OBJECTIVE: To report a case of bisphosphonate-induced osteonecrosis treated with the assistance of PBM and PDT. METHODOLOGY: This study is a descriptive case report study. RESULTS: Female patient undergoing treatment for a squamous cell carcinoma of the breast, underwent auxiliary treatment with 22 doses of Zometa® 4mg/100mL. Eight weeks later, the patient returned to the oncology unit complaining of a “hole in the mouth”. On clinical examination, drainage of purulent exudate was noticed in the lower alveolar ridge on the left side. Periapical and panoramic radiographs showed radiolucent image with imprecise limits and bone sequestration. Thus, the diagnosis established was bisphosphonate-induced osteonecrosis. The proposed treatment was surgical curettage, associated with PBM and PDT. A surgical curettage was performed and, after that, 40 sessions of FBM and PDT. For PDT, the dye, 0.01% methylene blue, was applied into the exposed bone for 5 minutes, with reapplication every 30 seconds. It was used the laser at a wavelength of 660nm, with energy of nine joules per point at nine points. For PBM, laser at a wavelength of 808nm, energy of three joules per point in nine points, was used. The patient had remission of the lesion and is currently under follow-up for five months, with no clinical signs of recurrence. CONCLUSION: Through the present case, we conclude that FBM and PDT were important auxiliary methods for the treatment of bisphosphonate-induced osteonecrosis.