Bisphosphonates are a class of drugs increasingly used in the treatment of osteoporosis and bone metastases. Despite their recognized benefits and, therefore, wide use, they can have devastating consequences. Recently recognized, osteonecrosis of the jaw associated with bisphosphonate use has been an entity increasingly seen in the context of Otolaryngology, Maxillofacial and Dental Medicine. As a new entity, there are still few reports and studies to define the best approach to this pathology.

Review of the literature about BRONJ and description of two patients with BRONJ and the two different approaches that were taken.

We report 2 cases distinct in their resolution. The first one, a female patient, with 45 years old, with a history of use of zoledronic acid for 16 years presented with bone exposion in the upper jaw and lower jaw, in the incisive region. She underwent a partial maxillectomy and left anterior marginal mandibulectomy with direct suture in the mucosa. To date, no recurrence. The other patient, 72 years old, had treatment with zoledronic acid and clodronic acid for five years. She presented with osteonecrosis of the upper jaw but, due to poor general condition, was not subjected to surgical debridement. In a follow-up visit, it was observed that the area of ostenecrose disintegrated, with resolution of the problem.

These 2 cases illustrate the difficulty in managing this entity, and that a “wait and see” may be as valid as surgical debridement. There are still missing guidelines based on randomized trials to define which approach is the best.