Bedogni Alberto, Blandamura Stella, Lokmic Zerina, Palumbo Carla, Ragazzo Mirko, Ferrari Francesca, Tregnaghi Alberto, Pietrogrande Francesco, Procopio Olindo, Saia Giorgia, Ferretti Marzia, Bedogni Giorgio, Chiarini Luigi, Ferronato Giuseppe, Ninfo Vito, Lo Russo Lucio, Lo Muzio Lorenzo, Nocini Pier Francesco
Unit of Dentistry and Maxillofacial Surgery, University of Verona, Verona, Italy.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Mar;105(3):358-64. doi: 10.1016/j.tripleo.2007.08.040.
Recently, jawbone osteonecrosis has been reported as a potential adverse effect of bisphosphonates administration. This paper considers and highlights histopathologic and radiologic features of this condition.
Eleven patients, owing to unresponsiveness to conservative treatment and uncontrollable pain, underwent surgical resection of diseased jawbone after extensive hyperbaric oxygen therapy. A thorough clinical, laboratory, and imaging study was performed. Surgical specimens underwent histopathologic and immunohistochemical evaluation.
Computerized tomography (CT) scans showed increased bone density, periosteal reaction, and bone sequestration in advanced stages. With magnetic resonance imaging (MRI), exposed areas showed a low signal in T1- and T2-weighted and inversion recovery images, which suggests low water content and is histopathologically correlated with paucity in cells and vessels (osteonecrotic pattern). Unexposed diseased bone was characterized by T1 hypointensity and T2 and IR hyperintensity, which suggests high water content and inflammation, associated with hypercellularity, osteogenesis, and hypervascularity (osteomyelitic pattern).
Diseased bone extends beyond the limits of the bone exposed in the oral cavity. Histopathologic examination correlated well with CT and MRI, which are the choice for the evaluation of bisphosphonate-associated jawbone osteonecrosis.
最近，有报道称颌骨骨坏死是双膦酸盐给药的一种潜在不良反应。本文探讨并强调了这种病症的组织病理学和放射学特征。
11例患者因对保守治疗无反应且疼痛无法控制，在接受广泛的高压氧治疗后，对患病颌骨进行了手术切除。进行了全面的临床、实验室和影像学研究。手术标本进行了组织病理学和免疫组化评估。
计算机断层扫描（CT）显示，在疾病晚期骨密度增加、骨膜反应和骨质分离。磁共振成像（MRI）显示，暴露区域在T1加权、T2加权和反转恢复图像中呈低信号，这表明含水量低，在组织病理学上与细胞和血管稀少相关（骨坏死模式）。未暴露的患病骨的特征是T1低信号、T2和IR高信号，这表明含水量高且有炎症，与细胞增多、骨生成和血管增多相关（骨髓炎模式）。
患病骨超出口腔内暴露骨的范围。组织病理学检查与CT和MRI结果相关性良好，CT和MRI是评估双膦酸盐相关颌骨骨坏死的首选方法。
