Torus Palatinus Osteonecrosis Related to Bisphosphonate: A Case Report
A 67-year-old white female reported spontaneous detachment of a bone fragment from her palate. She mentioned that there was a painful ulcer which had appeared 2 months before, with no response to bicarbonate, triamcinolone, and tetracyclines. There was improvement of the local pain after expelling the bone fragment. She had a 16-year history of osteoporosis treated with oral calcium 600 mg/day and alendronate 70 mg/week for the past 6 years. There were no other comorbidities such as diabetes or hypertension. She did not use any other medication and presented with torus palatinus and torus mandibularis not knowing when it started.\nThe clinical examination of the palate revealed a depression (approximately 0.5 cm) in the mucosal tissue on the left side of a torus palatinus (approximately 2.5 cm) without bone exposure and signs of inflammation or infection (fig. ). CT imaging showed prominent exostosis (torus) on the medial portion of the hard palate with discontinuity of the cortical bone on the left side (red arrow, fig. , fig. ), while the histopathology of the bone fragment confirmed necrotic bone tissue (fig. ). With this clinical report, history of BP use, physical examination, imaging and histopathology, the diagnostic conclusion was BP-related osteonecrosis of the torus palatinus. The patient's medication was discontinued and she was referred to a maxillofacial surgeon for the surgical removal of the torus palatinus.