Fatal Bleeding in Conjunction with Mandibular Medication-related Osteonecrosis of the Jaw (MRONJ)
Fatal Bleeding in Conjunction with Mandibular Medication-related Osteonecrosis of the Jaw (MRONJ)
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DOI：
10.2209/tdcpublication.2016-0052
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发表时间：
2018-01-01
影响因子：
0.5
通讯作者：
Sakamoto, Haruo
中科院分区：
文献类型：
--
作者：
Suzuki, Taiki;Sekiya, Ryo;Sakamoto, Haruo
在这里，我们报告一个致命出血合并下颌骨药物相关性骨坏死（MRONJ）的病例。一位75岁的日本男性因前列腺癌多发骨转移而使用双膦酸盐（BP）致颌骨骨坏死而转介至我科。由于预期寿命预后不佳，排除了积极的手术干预。死亡原因是下颌骨坏死导致大量口腔出血，导致失血性休克。大量报道表明，颌骨坏死不仅是由BP引起的，RANKL抗体、类固醇和分子靶向药物也可引起颌骨坏死。这表明，在一般健康状况已经很差的老年患者中，MRONJ病例的数量可能会增加。美国口腔颌面外科协会建议，只有在第三期疾病的情况下，才需要积极的治疗。因此，这种治疗策略可能只适用于颌骨坏死的病例，其中患者的总体健康状况良好。为了防止MRONJ病例出现危及生命的结果，负责确定药物策略的医生应与口腔外科医生合作，确定最佳治疗策略。
Here, we report a case of fatal bleeding in conjunction with mandibular medication-related osteonecrosis of the jaw (MRONJ). A 75-year-old Japanese man was referred to our department with osteonecrosis of the jaw due to bisphosphonate (BP) for multiple bone metastases from prostate cancer. Aggressive surgical intervention was ruled out due to a poor prognosis in terms of life expectancy. Death occurred due to hemorrhagic shock resulting from massive oral bleeding caused by necrosis of the mandible. Numerous reports have suggested that jaw necrosis is induced not only by BP, but also RANKL antibody, steroids, and molecularly-targeted agents. This suggests that the number of cases of MRONJ is likely to increase among elderly patients in whom general health is already poor. The American Association of Oral and Maxillofacial Surgery recommends aggressive treatment only in cases of stage 3 disease. Therefore, such a therapeutic strategy may only be available for cases of jaw necrosis in which the general health status of the patient is otherwise good. To prevent a life-threatening outcome in cases of MRONJ, physicians, who are responsible for determining the drug strategy, should cooperate with oral surgeons in determining the best therapeutic strategy.