Worsening of osteonecrosis of the jaw during treatment with sunitinib in a patient with metastatic renal cell carcinoma.

We report on the potential association of suspected bisphosphonate-associated osteonecrosis of the jaw (BRONJ) recurrence with the use of the novel antiangiogenic drug sunitinib. A 59 year-old patient affected by metastatic renal cell carcinoma (RCC) and established BRONJ experienced consecutive episodes of painful jaw infection with cutaneous fistula and bone sequestration which occurred during active treatment with sunitinib, improved after discontinuation and antibiotic therapy, then rapidly worsened with resumption of sunitinib. We hypothesize that the potent antiangiogenic activity of sunitinib may amplify the inhibition of bone remodeling exerted by aminobisphosphonates entrapped within the osteonecrotic mineral matrix, antagonize mucosal healing and expose to infections during treatment. This supports the emerging role of soft-tissue damage in the pathogenesis of osteonecrosis of the jaw.

[An unusual jugal abscess after third molar extraction: a complication of hemostatic wax]. / " Abcès atypique" jugal après extraction de dents de sagesse: complication de l'utilisation de cire hémostatique.

Bleeding is a common complication after third molar extraction. Hemostatic agents can be helpful in controlling intraoperative bleeding. Infection is another common complication. Horseley's wax is frequently used for bone surgery and less often for dental surgery. We report an unusual case of abscess formation in the jaw after third molar extraction. Surgical exploration of the abscess disclosed the presence of surgical wax in the center of a foreign body granuloma. We discuss the use of surgical wax and other local hemostatic agents and the subsequent risk of complications.