Pathophysiology of Osteonecrosis of the Jaws.
Pathophysiology of Osteonecrosis of the Jaws.
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DOI：
10.1016/j.coms.2015.06.001
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发表时间：
2015-11
影响因子：
1.5
通讯作者：
Tetradis S
中科院分区：
文献类型：
--
作者：
Aghaloo T;Hazboun R;Tetradis S
颌骨骨坏死（Osteonecrosis of the jaw， ONJ）的定义是：因原发性或转移性骨癌、骨质疏松症或Paget病而接受抗吸收药物治疗的患者，颌骨暴露坏死骨至少8周，且没有颌骨放射治疗史[1,2]。最近，美国医学科学院（AAOMS）修订了定义，包括外暴露的骨，或在服用抗吸收或抗血管生成药物的患者中可以通过口内或口外瘘探查的骨。在病例定义中加入“探查骨”具有临床意义，因为暴露的骨并不总是可见的，即使它明显坏死且放射学相似。疾病的分期是基于症状的严重程度和临床及影像学表现的程度。2009年和2014年AAOMS的立场文件概述了包括0期在内的疾病阶段，其中没有直接的骨暴露[2,3]。慢性暴露，坏死骨，炎症，肿胀，疼痛和影像学改变是一些更常见的临床表现。ONJ可以表现为细微的、通常被忽视的0期，表现为无任何疼痛或感染迹象的外露骨（I期），表现为伴有感染、疼痛、肿胀的外露骨（II期），或表现为在上颌骨或下颌骨的大节段形成广泛的疾病，并伴有口外瘘，累及重要结构或病理性骨折（III期）。
Osteonecrosis of the jaw (ONJ) was defined as exposed, necrotic bone in the maxillofacial region for at least 8 weeks in patients receiving an antiresorptive medication for primary or metastatic bone cancer, osteoporosis, or Paget’s disease, without history of radiation therapy to the jaws [1, 2]. Recently, the AAOMS revised the definition to include exposed bone, or bone that can be probed through an intraoral or extraoral fistula in patients on antiresorptive or antiangiogenic medications [3]. The addition of “probed bone” to the case definition is of clinical significance since frank exposed bone is not always seen, even though it is notably necrotic and radiographically similar.The staging of the disease is based on severity of symptoms and extent of clinical and radiographic findings [3]. The 2009 and 2014 AAOMS position papers outline the disease stages including Stage 0, where there is no frank bone exposure [2, 3]. Chronic exposed, necrotic bone, inflammation, swelling, pain and radiographic changes are some of the more common clinical findings. ONJ can present as subtle, commonly overlooked Stage 0, as exposed bone without any pain or signs of infection (Stage I), as exposed bone with associated infection, pain, swelling (Stage II), or as extensive disease that forms in large segments of the maxilla or mandible with extraoral fistulae, involvement of vital structures, or pathologic fracture (Stage III).