Aylin SipAhi ÇALIŞ, Candan EFEOĞLU, Bahar SEZER, Hüseyin KOCA

Kanser Hastalarında Bifosfonata Bağlı Osteonekroz (BRONJ): Retrospektif Çalışma

GİRİŞ ve AMAÇ: Bisfosfonatlar genellikle menapoz sonrası, kortikosteroidin artırdığı osteoporoz, Paget hastalığı, malinite ve osteolizis ile ilişkili hiperkalsemi ve metastatik kemik hastalıkları tedavisinde kullanılır. Bifosfonata bağlı osteonekroz çene (BRONJ), osteomiyelit, nekrotik kemiğin açığa çıkması gibi ciddi ağız komplikasyonlarına yol açabilir. Dişhekimleri bu komplikasyonların farkında olmalıdır ve defektli osteoklast fonksiyonu, azalmış kemik dokusu vasküleritesi nedeniyle yara iyileşmesinde bozukluğa neden olan bu ilacın tedavisini gören hasta grubunda gerekli özeni göstermelidir. YÖNTEM ve GEREÇLER: Bu çalışma, kanser hastalarında görülen BRONJ'un retrospektif bir araştırmasıdır. Analiz edilen veriler yaş, cinsiyet, sebep olan hastalık, tıbbi ve diş hikayesi, bifosfonatlar (BP) türünü içermektedir. BRONJ tanısı konan hastalarımızın lokal ve sistemik risk faktörleri, klinik ve radyolojik bulguları, tedavi stratejileri değerlendirildi. BULGULAR: En yaygın klinik osteonekroz bulguları, mandibularda enfeksiyon ve nekrotik kemik idi. İlişkili olaylar arasında diş çekimi, enfeksiyon ve travma yer alıyordu. Cerrahi müdahale, antibiyotik tedavisi, hiperbarik oksijen tedavisi ve topikal ağız gargaraların kullanımına rağmen bazı lezyonlar tedaviye iyi yanıt vermedi. İnatçı enfeksiyonu olan hastalar yeniden ameliyat edildi veya palyatif tedavi başlandı. TARTIŞMA ve SONUÇ: Bu çalışmanın sonuçları, diş çekmelerini ve protezlerin BRONJ gelişiminde risk faktörleri olduğu gerçeğini doğrulamıştır. Bifosfonat başlamadan önce, hastaların kapsamlı bir diş muayenesi olması gerekir. Diş problemi olan hastalar, bu ilaçların başlamasından önce diş hekimliğinde bakım altına alınmalıdır

Biphosphonate-Related Osteonecrosis (BRONJ) in Cancer Patients: Retrospective Study

INTRODUCTION: Bisphosphonates are commonly prescribed for the treatment of postmenopausal and corticosteroid induced osteoporosis, Paget’s disease, hypercalcemia associated with malignancy and osteolysis, associated with metastatic bone disease.Bisphosphonate-related osteonecrosis of jaw (BRONJ) may result in serious oral complication, such as osteomyelitis and chronic exposure of necrotic bone. Dentists must be familiar with this disorder and pay special attention to all patients on bisphosphonate therapy. METHODS: This was a retrospective review of BRONJ in cancer patients. Data analyzed included age, sex, underlying disease,medical and dental history, bisphosphonates(BP) types.Local and systemic risk factors, clinical and radiographic findings, treatment strategies of treatment of our patients who are diagnosed to have BRONJ are evaluated. RESULTS: The most common clinical osteonecrosis presentations included infection and necrotic bone in the mandible. Associated events included dental extraction infection and trauma. Despite surgical intervention antibiotic therapy hyperbaric oxygen therapy and topical use of chemotherapeutic mouth rinses, some of lesions did not respond well to therapy. Patients with persistent infection were re-operated or palliative treatment was started. DISCUSSION AND CONCLUSION: Before initiation of a bisphosphonate, patients should have a comprehensive dental examination. Patients with a challenging dental stiuation should have dental care attended to before initiation of these drugs

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