Bisphosphonate-related osteonecrosis of the skull base.

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is reported in up to 18.6% of patients treated with intravenous bisphosphonates and can result in significant morbidity. Most cases are managed by oral surgeons with only a handful of reports appearing in the otolaryngology literature. We present a unique case of extensive BRONJ involving the maxilla, sinuses, and skull base, complicated by sinusitis and an intracranial abscess. This is the first description of BRONJ involving the skull base. The pathogenesis and management of this process are reviewed.