Case Report: Maxillary Osteonecrosis In A Cushing’S Syndrome Patient

We provide a case report of maxillary osteonecrosis in a patient with Cushing's syndrome (CS). Cushing's syndrome, characterized by chronic glucocorticoid excess, carries well-documented risks of avascular osteonecrosis predominantly linked to high-dose corticosteroid exposure. A 52-year-old male with Cushing's syndrome secondary to bronchial neuroendocrine tumor, maintained in postoperative remission since 2016, presented with progressive gingival swelling, purulent rhinorrhea, and halitosis persisting for one month. Intraoral examination identified a vertical crown-root fracture of tooth 26 accompanied by surrounding soft-tissue edema and purulent discharge in the left maxillary buccal vestibule. Cone-beam computed tomography (CBCT) demonstrated extensive osteolytic lesions extending from the alveolar bone in the left maxillary premolar and molar regions to the sinus floor, indicative of fracture-induced osteonecrosis. The patient underwent combined dental extraction, surgical debridement, and endoscopic sinus surgery with successful resolution. Chronic glucocorticoid exposure impairs bone remodeling via osteoblast dysfunction and vascular compromise, typically causing avascular necrosis in weight-bearing joints. This case demonstrates maxillary osteonecrosis due to odontogenic infection, rare given the region’s vascularity. Bisphosphonates treat steroid-induced osteoporosis but risk jaw necrosis, necessitating pre-treatment dental clearance and drug holidays. Multidisciplinary management combining dental intervention and sinus surgery succeeded. Symptom overlap with sinonasal malignancies underscores histopathological confirmation to differentiate inflammatory from neoplastic processes. This case highlights the critical role of multidisciplinary surgical management in odontogenic sinusitis, particularly in CS patients where maxillary osteonecrosis involves multifactorial pathogenesis with odontogenic infection as the primary instigator.