Magremanne M, Dufrasne L, Vervaet C, Daelemans P, Legrand W
Service de stomatologie et chirurgie maxillofaciale, CUB, hôpital Erasme, université libre de Bruxelles (ULB), 808, route de Lennik, 1070 Bruxelles, Belgique.
Rev Stomatol Chir Maxillofac. 2007 Dec;108(6):539-42. doi: 10.1016/j.stomax.2007.05.002. Epub 2007 Sep 27.
Jaw osteonecrosis is, in most cases, caused by external irradiation. It is otherwise a rare occurrence.
A 52-year-old patient was referred to this hospital for several tooth extractions. In the procedure follow-up, the external aspect of the mandible was more and more exposed. This led to the spontaneous loss of a voluminous bone fragment. The patient had never undergone radiotherapy or a course of bisphosphonates but had a long-term cardio-vascular history. He had undergone endarterectomy of both carotids, an ilio-femoral by-pass, and a coronary dilatation. The diagnosis of bone infarction on a chronic osteomyelitis was made.
Blood coagulation disorders are responsible for most cases of bone infarction. Other risk factors include local trauma, chemotherapy, corticoids, and bisphosphonates. Necrosis of the jawbones is rare even though these are prone to trauma and infections. Symptoms are not specific and imaging is contributive late in the evolution. The results of medical treatment (antibiotherapy, vasodilators, and hyperbaric oxygenotherapy) and surgical debridement are very inconsistent.
颌骨坏死在大多数情况下是由外部辐射引起的。在其他情况下则很少见。
一名52岁患者因多次拔牙被转诊至本院。在手术随访过程中，下颌骨外部越来越暴露。这导致一大块骨碎片自发脱落。该患者从未接受过放疗或双膦酸盐治疗，但有长期心血管病史。他接受过双侧颈动脉内膜切除术、髂股旁路手术和冠状动脉扩张术。诊断为慢性骨髓炎伴骨梗死。
血液凝固障碍是大多数骨梗死病例的病因。其他危险因素包括局部创伤、化疗、皮质类固醇和双膦酸盐。颌骨坏死很少见，尽管颌骨容易受到创伤和感染。症状不具特异性，影像学检查在病情发展后期才有帮助。药物治疗（抗生素治疗、血管扩张剂和高压氧治疗）和手术清创的效果非常不一致。
