Surgical treatment of bisphosphonate-associated osteonecrosis of the mandible: Report of two cases

Öz

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 Key words: Osteonecrosis, Bisphosphonate, jaw

Anahtar Kelimeler

• Osteonecrosis, Bisphosphonate, jaw

Mandibulada bifosfonat kullanımı sonucunda oluşan osteonekrozun cerrahi tedavisi: iki vaka raporu

Öz

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

Anahtar Kelimeler

• Osteonekroz, bifosfonat, çene

Kaynakça

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