Gonca Duygu ÇAPAR, FATİH CABBAR, CEYDA ÖZÇAKIR TOMRUK

Oral bifosfonat kullanımına bağlı çene kemiği osteonekrozu olgusunda patolojik mandibular kırık: derleme ve olgu sunumu

Bifosfonatlar (BP) osteoporoz, metastatik kemik tümörleri ve multiple myeloma gibi hastalıklarda iskeletsel komplikasyonların engellenmesi amacı ile kullanılan ilaçlardır. Bu durumlarda kullanıldıklarında her ne kadar hastaların yaşam kalitelerini arttırsalar da; sebep oldukları bazı yan etkiler bulunmaktadır. İlaca bağlı çene kemiği osteonekrozu da (İÇKON) diş hekimliğini yakından ilgilendiren yan etkilerinden biridir. İÇKON'un oluşumundaki risk faktörlerinin en önemlilerinden biri de BP'nin tipi ve verilen total dozudur. Özellikle intravenöz BP ile tedavi edilen hastalarda osteonekroz oluşma riski, oral BP kullanımına oranla çok daha yüksektir. Oral yolla BP kullanımında komplikasyon görülme sıklığı az olmasına rağmen; nadir de olsa İÇKON lezyonları görülebilmektedir. İÇKON'da, lezyonlar genellikle sarımsı beyaz renkli kemik alanları şeklindedir. Lezyon etrafında ülserasyonlar ve ekstraoral veya intraoral fistüller görülebilmektedir. Tedavi seçenekleri hastalığın evresine göre değişmektedir. İÇKON'un başlangıç evrelerinde semptomatik lokal ve/ veya sistemik antimikrobiyal ve analjezik tedavi tercih edilirken ilerleyen evrelerde lezyonun cerrahi olarak debrimanı veya rezeksiyonu tercih edilmektedir. İÇKON'un son evresinde mandibulada patolojik kırıklar oluşabilmesi ve bölgede azalan yara iyileşmesi potansiyeli bu durumu karmaşıklaştırmaktadır. Bu olgu raporunda, oral ibandronat kullanan 82 yaşındaki kadın hastada sol retromolar bölgede oluşan osteonekrotik alanın debrimanını takiben iyileşme sağlandıktan bir yıl sonra oluşan patolojik angulus kırığı sunulmaktadır.

Oral bisphosphonate induced osteonecrosis of the jaw causing pathological mandibularfracture: literature review and a case report

Bisphosphonates (BP) are drugs used to prevent skeletal complications of diseases like metastatic bone malignancies, multiple myeloma and osteoporosis. Although this group of drugs is improving patients' quality of life, they cause some adverse effects. One of these adverse effects is medication-related osteonecrosis of the jaw (MRONJ) and it is closely related to dental practice. The important risk factors causing MRONJ are the type and the total dosage of the drugs. Especially, patients taking intravenous BPs are more prone to suffering MRONJ lesions than those taking these medications orally. In oral BPs usage, there are few possibility to encounter complications, but MRONJ lesions could be observed in these patients. MRONJ lesions could be seen as yellowish bone areas sometimes with intra- or extraoral fistulas and surrounded ulcerative areas. Treatment options vary according to lesions' stage. In early stages ofMRONJ, symptomatic local or/and systemic antimicrobials and analgesics can be administered whereas in advanced stages, surgical debridement or resection are preferred. In the last stage of MRONJ, pathological mandible fractures could be observed and the decreased healing capacity of the area makes the situation more complicated. This case report presents an 82-year-old female using oral ibandronate with osteonecrosis in the left retromolar area and pathologic angular fracture of the mandible after one year following debridement of the osteonecrotic area.

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