Fig. 5.

A 72-year-old woman took pamidronate for 41 months due to idiopathic osteoporosis and experienced spontaneous bone exposure, pus discharge, and swelling at the left maxilla and right mandible. a Left maxillary alveolar bone was exposed, and the bisphosphonate-related osteonecrosis of the jaw (BRONJ) lesion of the left maxilla was of stage 2. b Osseous phase bone scintigraphy showed focal tracer uptakes at the left maxilla (black arrowhead) and right mandible (black arrow). In addition, tracer uptake in the left maxilla extended to the maxillary sinus area, suggesting maxillary sinusitis. Bone scintigraphic findings suggested a stage 3 BRONJ lesion of the left maxilla. c CT scan confirmed left maxillary sinusitis by a BRONJ lesion of the left maxilla (white arrow). The BRONJ lesion in the left maxilla was up-staged to stage 3 based on bone scintigraphy