Müge ÇINA AKSOY, Özge ŞAHİN KOLKESEN, Gülperi KOÇER, Timuçin BAYKUL

Bifosfonata bağlı çene kemiklerinde gelişen osteonekroz: Atipik klinik görüntü

Bifosfonata bağlı çenelerde görülen osteonekrozun klinik bulguları, ekspoze nekrotik kemik yüzeyi, ağrı, enflamasyon, pürülan akıntı olarak sayılabilmektedir. Karakteristik klinik görüntü olan ekspoze nekrotik kemiğin olmaması, teşhisin güçleşmesi, tedavinin başarısızlığı ve uzamasına neden olabilmektedir. 56 yaşındaki kadın hasta, kliniğimize, sağ alt çenede ağrı şikayetiyle başvurdu. Yapılan klinik ve radyografik muayenesi sonucu bifosfonata bağlı Evre 2 osteonekroz teşhisiyle cerrahi debridman yapıldı. Kontroller sırasında mukozanın tam olarak iyileştiği, ancak kemik nekrozunun sağlam mukoza altında devam ettiği tespit edildi. Sekestrektomi ve küretaj ile ikinci cerrahi işlem yapıldı. Evre iki hastalarda konservatif tedavi sonrası hastanın uzun süreli takibi yapılmalı, primer teşhiste ekspoze nekrotik kemik varlığı olmaksızın gelişen osteonekrozlarda olduğu gibi, cerrahi debridman sonrası mukozada iyileşme gözlense de sağlam mukoza altında kemik nekrozunun devam edebileceği akılda tutulmalıdır.

Biphosphonate related osteonecrosis of the jaws: Atypical clinical appearance

The clinical signs of Bisphosphonate related osteonecrosis of the jaws are exposed necrotic bone, pain, inflammation and pus drainage. The absence of exposed necrotic bone, a characteristic clinical sign, can lead to late diagnosis and refractory treatment. 56-year-old female patient, admitted to our clinic with a complaint of pain in the right lower jaw. Clinical and radiographic examination showed Stage 2 bisphosphonate related osteonecrosis and surgical debridement was performed; after surgery the mucosa healed completely, but it was determined that bone necrosis continued under the intact mucosa. A second surgery with sekestrectomy and curretage was performed. The Stage 2 patients should be followed up long-term after conservative treatment, as well as the primary diagnosis of bisphosphonate related osteonecrosis of the jaws without exposed necrotic bone, after surgical debridement, mucosal healing can completed and the bone necrosis may continue under the intact mucosa.

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