BİFOSFONAT KULLANIMINA BAĞLI ÇENE KEMİKLERİNDE GÖRÜLEN OSTEONEKROZ VAKALARININ MEDİKAL VE CERRAHİ TEDAVİLERİ SONRASI UZUN DÖNEM TAKİPLERİ

Yıl 2019, Cilt: 29 Sayı: 1, 89 - 97, 15.01.2019

Necip Fazıl Erdem , Zeynep Gümüşer

https://doi.org/10.17567/ataunidfd.522770

Öz

Amaç: Bu çalışman amacı bifosfonata bağlı çene
kemiğinin osteonekrozu (Bisphosphonate Related Osteonecrosis of the Jaws
[BRONJ]) tanısı konmuş hastaların, yapılan
medikal ve cerrahi tedavileri sonra- sında tedavilerinin başarısını görmek ve
uzun dönem takibin önemini vurgulamaktır.

Gereç
ve Yöntem: BRONJ tanısı konulmuş, altısı kadın ikisi erkek olmak üzere 8
hastanın ilaç ve cerrahi tedavileri ve uzun dönem klinik ve radyolojik takip
sonuçları değerlendirilmiştir.  Ruggiero
ve arkadaşları- nın oluşturduğu evrelendirmeye göre vakalar evrelen- dirilmiş
ve tedavileri yapılmıştır. Hastaların üçü osteo- poroz (biri intravenöz, ikisi
oral yoldan), kalan beşi malignite (intravenöz yoldan) nedeneniyle bifosfonat
kullanmaktadır.

Bulgular: Hastalar 8
ila 43 ay arasında değişen, ortalama 23.8 aylık süreyle bifosfonat grubu ilaç
almışlardır. Hastaların ortalama yaşları 61.2 ve tedavi sonrası ortalama takip
süreleri ise 12.5 aydır. , 8 vakanın beşi evre 3, diğer üçü ise evre 2 olarak
değer- lendirilmiştir. Evre 3 hastaların hiçbirinde, medikal ve cerrahi tedavi
sonrası belirtilen takip süresince klinik ve radyolojik olarak BRONJ rekürrensi
görülmemiştir. Evre 2 vakalarda ise ilaç tedavisi sonrası hastalık semptomatik
olarak kontrol altına alınmıştır.

Sonuç :
Sonuç olarak uygulanan bu tedavi protokolü ve bu çalışmaya dahil edilen
vakalardan elde edilen veriler, cerrahi tedavinin gerektiğinde uygun zamanda yapılmasının
önemini güçlendirmiştir. Ayrıca hiperbarik oksijen tedavisinin BRONJ
vakalarında yardımcı tedavi yöntemlerinden biri olarak düşünülebileceği söylene-
bilir. Bifosfonat kullanım nedenleri hastaların cerrahi ya da medikal yolla
tedavi edilmelerinde direkt olarak etkili olmamıştır.

Anahtar kelimeler: Bifosfonat, çene osteonekrozu, hiperbarik
oksijen tedavisi

LONG TERM FOLLOW UP OF PATIENTS WITH BISPHOSPHONATE
RELATED OSTEONECROSIS OF THE JAWS AFTER MEDICAL AND SURGICAL TREATMENT

ABSTRACT

Aim: The aim of this study is to observe the success
of medical and surgical treatment of the patients who have been diagnosed as
the bisphosphonate related osteonecrosis of the jaws (BRONJ) and emphasize the
importance of long term follow up of these patients. Material and Methods: The medical and surgical treatments and long
term clinical and radiological follow ups of 8 BRONJ cases, of whom 6 women and
2 men, were evaluated in this study. All cases were staged according to a
staging system that was imple- mented by Ruggiero et al. and treated
accordingly. Three of the patients (one intravenously and two orally) were on
bisphosphonate due to osteoporosis and five of them (intravenously) due to
malignant diseases. Results: Patients
were on bisphosphonate for an interval of 8 to 43 months with a mean time
period of 23.8 months. The mean age of the patients was 61.2 and the mean
postoperative follow up time was 12.5 months. According to Ruggiero et al BRONJ
staging, 5 of 8 cases were at stage-3 and the rest of them were at stage-2.
None of the stage-3 cases that were treated medically and surgically showed any
BRONJ recurrence clinically and radiographically during their follow up
periods. Also, all three stage-2 BRONJ cases were kept under control
symptomatically with medical treatment protocol. 

Conclusion: As a conclusion, the treatment
protocol and outcome data of this study on BRONJ cases have reinforced the
importance of surgical treatment that is performed at an appropriate time.  Also it is possible to emphasize that
hyperbaric oxygen treatment can be an adjuvant treatment method for BRONJ
cases. The reason of bisphosphonate usage of these patients did not directly
have any effect on either they treated surgically or medically.Key Words: Bisphosphonate, jaw osteonecrosis, hyperbaric oxygen treatment

Anahtar Kelimeler

Bifosfonat, çene osteonekrozu

Kaynakça

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