Surgical treatment of bisphosphonate-associated osteonecrosis of the mandible: Report of two cases
Bifosfonatlar osteoporoz ve kemik metastazı gibi hastalıklardaki kemik yıkımını azaltmaktadır. Artan bifosfonat kullanımıyla birlikte çenelerde görülen bifosfonatla ilişkili osteonekrozda yaygınlaşmaktadır. Kliniğimize alt çenede püy akıntısı ve ağrı şikayeti ile başvuran 64 ve 56 yaşında iki bayan hastanın bifosfonat kullanımıyla ilişkili osteonekroz vakalarını sunuyoruz. Her iki vakada uzun dönem bifosfonat kullanımına bağlı osteonekroz teşhisi konuldu. Tıbbi ve cerrahi tedavi planlaması yapıldı. Hastalara Klorheksidin irrigasyonu ve antibiyotik reçete edildi. Daha sonra lokal anestezi altında kemik debridmanı yapıldı. Her iki hastada çok iyi iyileşme görüldü. Bifosfonatla ilgili osteonekroz tedavisi için önerilen çok sayıda protokol bulunmaktadır. Çoğu hastada konservatif bir yaklaşım olarak nekrotik kemiğin geniş debridmanı ve küçük lokal girişimler yeterlidir ancak çok az vakada bu girişimler başarısız olursa radikal olarak kemiği rezeke etmek gerekmektedir
Mandibulada bifosfonat kullanımı sonucunda oluşan osteonekrozun cerrahi tedavisi: iki vaka raporu
Bisphosphonates are used to reduce skeletal-related events in patients with bone-consuming diseases, such as osteoporosis and bone metastases. Bisphosphonaterelated osteonecrosis of the jaw (BRONJ) is becoming increasingly common with increasing use of bisphosphonates. We present two cases of BRONJ in a 64-year-old female and a 56-year-old female who were admitted to our department with complaints of purulent discharge and pain of the lower jaw. Both patients had been taking bisphosphonate and were diagnosed with jaw osteonecrosis, which can occur due to long-term use of bisphosphonate. The patients underwent medical treatment, including chlorhexidine rinses and antibiotics. Bone debridement was then performed under local anaesthesia. Both patients recovered well. There are many protocols, guidelines and suggestions on the management of BRONJ. For most patients, a conservative approach with minimal local intervention, if necessary, is appropriate, with extensive debridement of necrotic bone when this fails. In a small number of cases, radical resection of bone and reconstruction may be required. J Clin Exp Invest 2015; 6 (1): 61-64
___
- Pit JV, Joel JO, Alice KM. Surgical treatment of bisphos- phonate-associated osteonecrosis of the jaw. J Cranio Maxill Surg 2012;40:719-725.
- Rathan MS, Gary MM. Bisphosphonate induced os- teonecrosis of the mandible. Eur J Radiology Extra 2008;66:9-11.
- Tomoaki S, Mutsumi M, Ryouji T. Bisphosphonate-related osteonecrosis of the jaw successfully treated with surgi- cal resection and its histopathological features: A long- term follow-up report. J Oral Maxill Surg Pathol Med 2014;275:4-8.
- Robert E. M. Pamidronate (Aredia) and zoledronate (Zo- meta) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxill Surg 2003;6:1115-1118.
- Robert EM, Yoh S, Michel F, Vishtasb B. Bisphospho- nate-induced exposed bone (osteonecrosis/osteope- trosis) of the jaws: risk factors, recognition, prevention, and treatment: J Oral Maxill Surg 2005;63:1567-1575.
- Cesar AM. Bisphosphanates and oral cavity avascular bone necrosis: J Clin Oncol 2003;21:4253-4254.
- American Association of Oral and Maxillofacial Surgeons. Position paperon bisphosphonate-related osteonecro- sis of the jaws; 2006. Available at: http://www.aaoms. org/docs/position papers/osteonecrosis.pdf.
- Cesar AM, Michael AS, Linda SE. Bisphosphonate- associated osteonecrosis: a long-term complication of bisphosphonate treatment: Lancet Oncol 2006;7:508- 514.
- Ian RR. Osteonecrosis of the jaw -- Who gets it, and why? Bone 2009;44:4-10.
- PF Nocini, G Saia, G Bettini. Vascularized fibula flap re- construction of the mandible in bisphosphonate-related osteonecrosis. The J Cancer Surg 2009;35:373-379.
- Lerman MA, Xie W, Treister NS. Conservative man- agement of bisphosphonate-related osteonecrosis of the jaws Staging and treatment outcomes. Oral Oncol 2013;49:977-983.
- Curi MM, Cossolin GS, Koga DH. Bisphosphonate-re- lated osteonecrosis of the jaws--An initial case series report of treatment combining partial bone resection and autologous platelet-rich plasma. J Oral Maxill Surg 2011;69:2465-2472.
- Lee CY, David T, Nishime M. Use of platelet- rich plasma in the management of oral bisphosphonate-associated osteonecrosis of the jaw: A report of 2 cases. J Oral Im- plantol 2007;32:371-382.
- Pripatnanont P, Nuntanaranont T, Vongvatcharanon S, et al. The primacy of platelet-rich fibrin on bone regen- eration of various grafts in rabbit's calvarial defects. J Cranio Maxill Surg 2013;41:191-200.
- Dhoan DMJ, Choukroun AD, et al. Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part III: Leucocyte activation: A new feature for platelet con- centrate? Oral Surgery Oral Med Oral Pathol Oral Ra- diol Endod 2006;101:51-55.
- Dhoan DMJ, Ehrenfest GM, de Peppo P, et al. Slow release of growth factors and thrombospondin-1 in Choukroun's platelet-rich fibrin (PRF): A gold standard to achieve for all surgical platelet concentrates technol- ogies. Growth Factors 2009;27:63-69.
- Lin JH, Russell G, Gertz B. Pharmacokinetics of alendro- nate: an overview. Int J Clin Pract Suppl 1999;101:18- 26.
- Agrillo A, Lingari C, Filiaci F, et al. Ozone Therapy in the Treatment of Avascular Bisphosphonate-Related Jaw Osteonecrosis. J Craniofac Surg 2007;18:1071-1075.
- Marx RE. Oral and Intravenous Bisphosphonates- lnduced Osteonecrosis of the Jaws: History, etiology, prevention and treatment. Hanover Park: Quintessence Books. 2006.