Bisphosphonate related osteonecrosis of the jaws: atypical clinical appearance

Abstract

INTRODUCTION: The clinical signs of Bisphosphonate related osteonecrosis of the jaws are exposed necrotic bone, pain, inflammation and pus drainage. The absence of characteristic clinical signs of bisphosphonate related osteonecrosis of the jaws, specifically exsposed necrotic bone, can lead to late diagnosis and refractory treatment. CASE REPORT: 56-year-old female patient, was 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. CONCLUSION: The patient 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. In this cases, sekestrectomy, primary closure of the wound and aggressive antibiotic therapy should be preferred. Key Words: Bisphosphonates, osteonecrosis, necrotic bone.

Keywords

• Bisphosphonates, osteonecrosis, exposed necrotic bone

Bifosfonat kullanımına bağlı olarak gelişen osteonekroz: atipik klinik görüntü

Abstract

GİRİŞ: Bifosfonata bağlı çenelerde görülen osteonekrozun klinik bulguları, ekspoze nekrotik kemik yüzeyi, ağrı, enflamasyon, pürülan akıntı olarak sayılabilmektedir. Bifosfonata bağlı çene kemiklerinde gelişen osteonekrozun karakteristik klinik olarak ekspoze nekrotik kemiğin olmaması, teşhisin güçleşmesi, tedavinin başarısızlığı ve uzamasına neden olabilmektedir. VAKA RAPORU: 56 yaşındaki kadın hasta, kliniğimize, sağ alt çenede ağrı şikayetiyle başvurmuştur. Yapılan klinik ve radyografik muayenesi sonucu bifosfonata bağlı Evre 2 osteonekroz teşhisiyle cerrahi debridman yapılmış; kontroller sırasında mukozanın tam olarak iyileştiği, ancak kemik nekrozunun sağlam mukoza altında devam ettiği tespit edilmiştir. SONUÇ: 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 ettiği durumlarda, sekestrektomi, yaranın primer kapatılması ve agresif antibiyotik tedavisi tercih edilmelidir. Anahtar kelimeler: Bifosfonat, osteonekroz, nekrotik kemik.

Keywords

• Bifosfonat, osteonekroz, ekspoze nekrotik kemik

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