Medication-related osteonecrosis of the jaw: Clinical and practical guidelines.
Medication-related osteonecrosis of the jaw: Clinical and practical guidelines.
复制标题
颌骨与药物有关的骨坏死：临床和实用指南。
DOI：
10.4103/2231-0762.178742
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发表时间：
2016-03
影响因子：
1.1
通讯作者：
Pompa G
中科院分区：
文献类型：
--
作者：
Rosella D;Papi P;Giardino R;Cicalini E;Piccoli L;Pompa G
药物相关性颌骨骨坏死（MRONJ）是一种严重的药物不良反应，包括患者颌面部的进行性骨破坏。ONJ可由两种药物引起：抗吸收剂（包括双膦酸盐（BP）和核因子κ B受体激活剂配体抑制剂）和抗血管生成剂。MRONJ病理生理学尚未完全阐明。有几种假设可以解释其在颌骨的独特定位：炎症或感染、微创伤、骨重塑改变或骨吸收过度抑制、血管生成抑制、软组织BP毒性、口腔特有的生物膜、下颌骨的终末血管形成、免疫抑制或维生素D缺乏。牙科筛查和适当的治疗是降低骨坏死风险的基础，在抗吸收或抗血管生成治疗的患者，或在开始管理。MRONJ的治疗通常很困难，最佳治疗策略仍有待建立。因此，预防更为重要。建议由一名牙医、一名肿瘤科医生和一名颌面外科医生组成的多学科团队来评估和决定患者的最佳治疗方案。保守治疗和手术之间的选择并不容易，应该根据具体情况进行。然而，最初的方法应尽可能保守。对于已确诊MRONJ的患者，最重要的治疗目标主要是控制感染、骨坏死进展和疼痛。本文的目的是代表目前的知识MRONJ，其预防措施和管理策略。
Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse drug reaction, consisting of progressive bone destruction in the maxillofacial region of patients. ONJ can be caused by two pharmacological agents: Antiresorptive (including bisphosphonates (BPs) and receptor activator of nuclear factor kappa-B ligand inhibitors) and antiangiogenic. MRONJ pathophysiology is not completely elucidated. There are several suggested hypothesis that could explain its unique localization to the jaws: Inflammation or infection, microtrauma, altered bone remodeling or over suppression of bone resorption, angiogenesis inhibition, soft tissue BPs toxicity, peculiar biofilm of the oral cavity, terminal vascularization of the mandible, suppression of immunity, or Vitamin D deficiency. Dental screening and adequate treatment are fundamental to reduce the risk of osteonecrosis in patients under antiresorptive or antiangiogenic therapy, or before initiating the administration. The treatment of MRONJ is generally difficult and the optimal therapy strategy is still to be established. For this reason, prevention is even more important. It is suggested that a multidisciplinary team approach including a dentist, an oncologist, and a maxillofacial surgeon to evaluate and decide the best therapy for the patient. The choice between a conservative treatment and surgery is not easy, and it should be made on a case by case basis. However, the initial approach should be as conservative as possible. The most important goals of treatment for patients with established MRONJ are primarily the control of infection, bone necrosis progression, and pain. The aim of this paper is to represent the current knowledge about MRONJ, its preventive measures and management strategies.