Treatment of Osteonecrosis of the Jaw.
Treatment of Osteonecrosis of the Jaw.
复制标题
颌骨坏死的治疗。
DOI：
10.1097/scs.0000000000002127
复制
发表时间：
2015
影响因子：
0.9
通讯作者：
Iida S.
中科院分区：
文献类型：
--
作者：
Yamachika E;Matsubara M;Ikeda A;Matsumura T;Moritani N;Iida S.
双磷酸盐相关性颌骨坏死（BRONJ）的定义最近被扩大，现在被称为药物相关性颌骨坏死（MRONJ）。迄今为止，MRONJ 的管理仍存在争议。建议保守治疗，但3期MRONJ很难成功治疗。仅在独立病例报告中记录了使用特立帕肽治疗 MRONJ，并且很少有关于患有 MRONJ 的男性接受特立帕肽治疗的报告。 2014 年 5 月，一名 81 岁男子被转诊治疗下颌未愈合的拔牙伤口。由于治疗骨质疏松症，他服用米诺膦酸水合物（1毫克/天口服）2年。临床检查发现左下颌第一磨牙区软组织肿胀延伸至下颌下缘，并有口外瘘。计算机断层扫描（CT）显示骨质溶解延伸至下缘，导致下颌骨病理性骨折。根据这些发现，诊断为 MRONJ 3 期。我们进行了保守治疗，包括阿莫西林，但他的症状没有改善。然后，他接受每周一次皮下注射特立帕肽治疗。尽管开始注射特立帕肽时不使用抗生素，但1周后，口外瘘的肿胀、红斑和脓性分泌物迅速增加。因此，我们将每周一次的特立帕肽注射液与阿莫西林联合给药。三个月后，坏死愈合，CT显示下颌病理性骨折有明显的骨再生和愈合。此外，下颌瘘管已愈合，口内瘘管被正常粘膜覆盖。
The definition of bisphosphonate-related osteonecrosis of the jaw (BRONJ) was recently broadened and it is now known as medication-related osteonecrosis of the jaw (MRONJ). To date, the management of MRONJ is controversial. Conservative treatment is recommended, but it is difficult to successfully treat stage 3 MRONJ. Administration of teriparatide for the MRONJ treatment has only been documented in independent case reports and there are few reports on men with MRONJ treated with teriparatide. An 81-year-old man was referred in May 2014 for treatment of an unhealed tooth extraction wound in the mandible. He took minodronic acid hydrate (1 mg/d orally) for 2 years because of osteoporosis cure. On clinical examination, soft tissue swelling in the left mandibular first molar region extended to the inferior border of the mandible with extraoral fistula. Computed tomography (CT) revealed osteolysis extending to the inferior border resulting in pathologic fracture of mandibular bone. Based on these findings, a diagnosis of stage 3 MRONJ was made. We performed conservative treatment, including amoxicillin, but his symptoms did not improve. He was then treated with once-weekly subcutaneous injection of teriparatide. Although teriparatide injections were started without antibiotics, after 1 week, swelling, erythema, and purulent discharge from the extraoral fistula increased rapidly. Therefore, we combined the once-weekly teriparatide injection with amoxicillin administration. Three months later, the osteonecrosis had healed and CT showed significant bone regeneration and healing of the mandibular pathologic fracture. In addition, the mandibular fistula showed healing and the intraoral fistula was covered with normal mucosa.