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Bisphosphonate related osteonecrosis of the jaws: atypical clinical appearance

Yıl 2015, Cilt: 6 Sayı: 1, 34 - 38, 27.04.2015

Öz

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.

Kaynakça

  • Ruggiero SL, Drew SJ. Osteonecrosis of the jaws and bisphosphonate therapy. J Dent Res 2007;86(11):1013-1021. 2. Marx RE. Pamidronate (Aredia) and Zoledronate (Zometa) Induced Avascular Necrosis of The Jaws: A Growing Epidemic. J Oral Maxillofac Surg 2003;61:1115-1118.
  • Woo SB, Hellstein JW, Kamlar JR. Narrative [corrective] review: bisphosphonates and osteonecrosis of the jaws. Ann Intern Med 2006;144:753-761.
  • Hortobagyi GN, Theriault RL, Porter L, Blayney D, Lipton A, Sinoff C, Wheeler H, Simeone JF, Seaman J, Knight RD. Efficacy of pamidronate in reducing skeletal complications in patients with breast cancer and lytic bone metastases. N Engl J Med 1996;335(24):1785-1791.
  • Gutta R, Louis PJ. Bisphosphonates and osteonecrosis of the jaws: science and rationale. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104(2):186-193.
  • Advisory Task Force on Bisphosphonate Related Osteonecrosis of the Jaws American Association of Oral Maxillofacial Surgeons. American Association of Oral Maxillofacial Surgeons position paper on bisphosphonate related osteonecrosis of the jaws. J Oral Maxillofac Surg 2007;65:396-377.
  • Ruggiero SL. Bisphosphonate-related osteonecrosis of the jaw: an overview. Ann N Y Acad Sci 2011;1218:38-46.
  • Fedele S, Porter SR, D’Aiuto F, Aljohani S, Vescovi P, Manfredi M, Arduino PG, Broccoletti R, Musciotto A, Di Fede O, Lazarovici TS, Campisi G, Yarom N. Nonexposed variant of bisphosphonate-associated osteonecrosis of the jaw: a case series. Am J Med 2010;123(11):1060-1064.
  • Junquera L, Gallego L. Nonexposed bisphosphonate- related osteonecrosis of the jaws: another clinical variant? J Oral Maxillofac Surg 2008;66(7):1516-1517.
  • Mawardi H, Treister N, Richardson P, Anderson K, Munshi N, Faiella RA, Woo SB. Sinus tracts--an early sign of bisphosphonate-associated osteonecrosis of the jaws? J Oral Maxillofac Surg 2009;67(3):593-601.
  • Hutchinson M, O’Ryan F, Chavez V, Lathon PV, Sanchez G, Hatcher DC, Indresano AT, Lo JC. Radiographic findings in bisphosphonate-treated patients with stage 0 disease in the absence of bone exposure. J Oral Maxillofac Surg 2010;68(9):2232-2240.
  • Patel S, Choyee S, Uyanne J, Nguyen A, Lee P, Sedghizadeh P, Kumar S, Lytle J, Shi S, Le A. Non-exposed bisphosphonate-related osteonecrosis of the jaw: a critical assessment of current definition, staging, and treatment guidelines. Oral Diseases 2012;18:625-632.
  • Jabbour Z, El-Hakim M, Mesbah-Ardakani P, Henderson JE, Albuquerque R Jr. The outcomes of conservative and surgical treatment of stage 2 bisphosphonate-related osteonecrosis of the jaws: a case series. Int J Oral Maxillofac Surg 2012;41(11):1404-1409.
  • Bamias A, Kastritis E, Bamia C, Moulopoulos LA, Melakopoulos I, Bozas G, Koutsoukou V, Gika D, Anagnostopoulos A, Papadimitriou C, Terpos E,Dimopoulos MA. Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: incidence and risk factors. J Clin Oncol 2005;23:8580-8587.
  • Marx RE, Cillo JE, Ulloa JJ. Oral Bisphosphonate-Induced Osteonecrosis: Risk Factors, Prediction of Risk Using Serum CTX Testing, Prevention, and Treatment. J Oral Maxillofac Surg 2007;65:2397-2410.
  • Woo SB, Hellstein JW, Kamlar JR. Systematic Review: Bisphosphonates and Osteonecrosis Ann Intern Med 2006;144:753-761.
  • Melo MD, Obeid G. Osteonecrosis of the jaws in patients with a history of receiving bisphosphonate therapy: strategies for prevention and early recognition. J Am Dent Assoc 2005;136(12):1675-1681.
  • Ruggiero SL, Fantasia J, Carlson E. Bisphosphonate- related osteonecrosis of the jaw: background and guidelines for diagnosis, staging and management. Oral Surg Oral Med Oral Path Oral Radiol Endod 2006;102(4):433-441.
  • AAOMS, 2009 http://www.aaoms.org/docs/position_ papers/bronj_update.pdf
  • Kobayashi Y, Hiraga T, Ueda A, Wang L, Matsumoto- Nakano M, Hata K, Yatani H, Yoneda T. Zoledronic acid delays wound healing of the tooth extraction socket, inhibits oral epithelial cell migration, and promotes proliferation and adhesion to hydroxyapatite of oral bacteria, without causing osteonecrosis of the jaw, in mice. J Bone Miner Metab 2010;28(2):165-175.
  • Font RF, Garcia ML, Martinez JMO. Osteochemonecrosis of the Jaws due to Bisphosphonate treatments: Update Med Oral Patol Oral Cir Bucal 2008;13:318-324.
  • Migliorati CA, Casiglia J, Epstein J, Jacobsen PL, Siegel MA, Woo S. Managing the care of patients with bisphosphonate- associated osteonecrosis. J Am Dent Assoc 2005;136:1658–1668.
  • Ruggiero SL, Mehrotra B. Bisphosphonate-related osteonecrosis of the jaw: diagnosis, prevention, and management Annu Rev Med 2009;60:85-96.
  • Bedogni A, Blandamura S, Lokmic Z, Palumbo C, Ragazzo M, Ferrari F, Tregnaghi A, Pietrogrande F, Procopio O, Saia G, Ferretti M, Bedogni G, Chiarini L, Ferronato G, Ninfo V, Lo Russo L, Lo Muzio L, Nocini PF. Bisphosphonate- associated jawbone osteonecrosis: a correlation between imaging techniques and histopathology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:358- 364.
  • Senel FC, Saracoglu Tekin U, Durmus A, Bagis B. Severe osteomyelitis of the mandible associated with the use of non- nitrogen-containing bisphosphonate (disodium clodronate): report of a case J Oral Maxillofac Surg 2007;65(3):562-565.
  • Hewson I, Syme D, Bruscino-Raiola F. Radical surgical treatment of bisphosphonate related osteonecrosis of the jaw. Aust Dent J 2012;57(2):227-230.
  • Marx RE, Sawatari Y, Fortin M, Broumand V. Bisphosphonate-induced exposed bone (osteonecrosis/ osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg 2005;63(11):1567- 1575.

Bifosfonat kullanımına bağlı olarak gelişen osteonekroz: atipik klinik görüntü

Yıl 2015, Cilt: 6 Sayı: 1, 34 - 38, 27.04.2015

Öz

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.

Kaynakça

  • Ruggiero SL, Drew SJ. Osteonecrosis of the jaws and bisphosphonate therapy. J Dent Res 2007;86(11):1013-1021. 2. Marx RE. Pamidronate (Aredia) and Zoledronate (Zometa) Induced Avascular Necrosis of The Jaws: A Growing Epidemic. J Oral Maxillofac Surg 2003;61:1115-1118.
  • Woo SB, Hellstein JW, Kamlar JR. Narrative [corrective] review: bisphosphonates and osteonecrosis of the jaws. Ann Intern Med 2006;144:753-761.
  • Hortobagyi GN, Theriault RL, Porter L, Blayney D, Lipton A, Sinoff C, Wheeler H, Simeone JF, Seaman J, Knight RD. Efficacy of pamidronate in reducing skeletal complications in patients with breast cancer and lytic bone metastases. N Engl J Med 1996;335(24):1785-1791.
  • Gutta R, Louis PJ. Bisphosphonates and osteonecrosis of the jaws: science and rationale. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104(2):186-193.
  • Advisory Task Force on Bisphosphonate Related Osteonecrosis of the Jaws American Association of Oral Maxillofacial Surgeons. American Association of Oral Maxillofacial Surgeons position paper on bisphosphonate related osteonecrosis of the jaws. J Oral Maxillofac Surg 2007;65:396-377.
  • Ruggiero SL. Bisphosphonate-related osteonecrosis of the jaw: an overview. Ann N Y Acad Sci 2011;1218:38-46.
  • Fedele S, Porter SR, D’Aiuto F, Aljohani S, Vescovi P, Manfredi M, Arduino PG, Broccoletti R, Musciotto A, Di Fede O, Lazarovici TS, Campisi G, Yarom N. Nonexposed variant of bisphosphonate-associated osteonecrosis of the jaw: a case series. Am J Med 2010;123(11):1060-1064.
  • Junquera L, Gallego L. Nonexposed bisphosphonate- related osteonecrosis of the jaws: another clinical variant? J Oral Maxillofac Surg 2008;66(7):1516-1517.
  • Mawardi H, Treister N, Richardson P, Anderson K, Munshi N, Faiella RA, Woo SB. Sinus tracts--an early sign of bisphosphonate-associated osteonecrosis of the jaws? J Oral Maxillofac Surg 2009;67(3):593-601.
  • Hutchinson M, O’Ryan F, Chavez V, Lathon PV, Sanchez G, Hatcher DC, Indresano AT, Lo JC. Radiographic findings in bisphosphonate-treated patients with stage 0 disease in the absence of bone exposure. J Oral Maxillofac Surg 2010;68(9):2232-2240.
  • Patel S, Choyee S, Uyanne J, Nguyen A, Lee P, Sedghizadeh P, Kumar S, Lytle J, Shi S, Le A. Non-exposed bisphosphonate-related osteonecrosis of the jaw: a critical assessment of current definition, staging, and treatment guidelines. Oral Diseases 2012;18:625-632.
  • Jabbour Z, El-Hakim M, Mesbah-Ardakani P, Henderson JE, Albuquerque R Jr. The outcomes of conservative and surgical treatment of stage 2 bisphosphonate-related osteonecrosis of the jaws: a case series. Int J Oral Maxillofac Surg 2012;41(11):1404-1409.
  • Bamias A, Kastritis E, Bamia C, Moulopoulos LA, Melakopoulos I, Bozas G, Koutsoukou V, Gika D, Anagnostopoulos A, Papadimitriou C, Terpos E,Dimopoulos MA. Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: incidence and risk factors. J Clin Oncol 2005;23:8580-8587.
  • Marx RE, Cillo JE, Ulloa JJ. Oral Bisphosphonate-Induced Osteonecrosis: Risk Factors, Prediction of Risk Using Serum CTX Testing, Prevention, and Treatment. J Oral Maxillofac Surg 2007;65:2397-2410.
  • Woo SB, Hellstein JW, Kamlar JR. Systematic Review: Bisphosphonates and Osteonecrosis Ann Intern Med 2006;144:753-761.
  • Melo MD, Obeid G. Osteonecrosis of the jaws in patients with a history of receiving bisphosphonate therapy: strategies for prevention and early recognition. J Am Dent Assoc 2005;136(12):1675-1681.
  • Ruggiero SL, Fantasia J, Carlson E. Bisphosphonate- related osteonecrosis of the jaw: background and guidelines for diagnosis, staging and management. Oral Surg Oral Med Oral Path Oral Radiol Endod 2006;102(4):433-441.
  • AAOMS, 2009 http://www.aaoms.org/docs/position_ papers/bronj_update.pdf
  • Kobayashi Y, Hiraga T, Ueda A, Wang L, Matsumoto- Nakano M, Hata K, Yatani H, Yoneda T. Zoledronic acid delays wound healing of the tooth extraction socket, inhibits oral epithelial cell migration, and promotes proliferation and adhesion to hydroxyapatite of oral bacteria, without causing osteonecrosis of the jaw, in mice. J Bone Miner Metab 2010;28(2):165-175.
  • Font RF, Garcia ML, Martinez JMO. Osteochemonecrosis of the Jaws due to Bisphosphonate treatments: Update Med Oral Patol Oral Cir Bucal 2008;13:318-324.
  • Migliorati CA, Casiglia J, Epstein J, Jacobsen PL, Siegel MA, Woo S. Managing the care of patients with bisphosphonate- associated osteonecrosis. J Am Dent Assoc 2005;136:1658–1668.
  • Ruggiero SL, Mehrotra B. Bisphosphonate-related osteonecrosis of the jaw: diagnosis, prevention, and management Annu Rev Med 2009;60:85-96.
  • Bedogni A, Blandamura S, Lokmic Z, Palumbo C, Ragazzo M, Ferrari F, Tregnaghi A, Pietrogrande F, Procopio O, Saia G, Ferretti M, Bedogni G, Chiarini L, Ferronato G, Ninfo V, Lo Russo L, Lo Muzio L, Nocini PF. Bisphosphonate- associated jawbone osteonecrosis: a correlation between imaging techniques and histopathology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:358- 364.
  • Senel FC, Saracoglu Tekin U, Durmus A, Bagis B. Severe osteomyelitis of the mandible associated with the use of non- nitrogen-containing bisphosphonate (disodium clodronate): report of a case J Oral Maxillofac Surg 2007;65(3):562-565.
  • Hewson I, Syme D, Bruscino-Raiola F. Radical surgical treatment of bisphosphonate related osteonecrosis of the jaw. Aust Dent J 2012;57(2):227-230.
  • Marx RE, Sawatari Y, Fortin M, Broumand V. Bisphosphonate-induced exposed bone (osteonecrosis/ osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg 2005;63(11):1567- 1575.
Toplam 26 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Olgu Sunumları
Yazarlar

Müge Çına Aksoy

Özge Kolkesen Şahin Bu kişi benim

Gülperi Koçer

Timuçin Baykul

Yayımlanma Tarihi 27 Nisan 2015
Gönderilme Tarihi 25 Temmuz 2013
Yayımlandığı Sayı Yıl 2015 Cilt: 6 Sayı: 1

Kaynak Göster

Vancouver Çına Aksoy M, Kolkesen Şahin Ö, Koçer G, Baykul T. Bifosfonat kullanımına bağlı olarak gelişen osteonekroz: atipik klinik görüntü. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi. 2015;6(1):34-8.

SDÜ Sağlık Bilimleri Dergisi, makalenin gönderilmesi ve yayınlanması dahil olmak üzere hiçbir aşamada herhangi bir ücret talep etmemektedir. Dergimiz, bilimsel araştırmaları okuyucuya ücretsiz sunmanın bilginin küresel paylaşımını artıracağı ilkesini benimseyerek, içeriğine anında açık erişim sağlamaktadır.