Osteonecrosis of the mandible in a patient with lung adenocarcinoma undergoing anti-angiogenic therapy with bevacizumab

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Bevacizumab is a recombinant monoclonal humanised antibody, designed to inhibit the binding ability of vascular endothelial growth factor to its receptor. Recently bevacizumab has been implemented in the treatment protocols against certain types of cancer. A 63-year-old Caucasian male patient with lung adenocarcinoma, presented in the OMFS clinic with a non-healing lesion of the mucosa at the region of tooth 17 including areas of exposed bone and presence of pus along with paraesthesia, distributed to the left side of the lower lip. The patient had undergone two chemotherapy cycles including IV bevacizumab which was administered once every 3 weeks in a dose of 15 mg/kg. The radiographic examination (Orthopantomogram, ConeBeamComputedTomography) revealed cortical erosion of the lingual plate on the posterior left mandibular region with involvement of the inferior alveolar nerve. A diagnosis of stage II osteonecrosis was established that was later confirmed by the histopathological evaluation and ruled out possible bone metastases. After 2 weeks of treatment with an empiric antibiotic regimen, the necrotic lesion was removed with surgical debridement and without complications. In the 6 months follow-up the diseased area was fully healed and the paraesthesia was improved.

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