Vescovi Paolo, Merigo Elisabetta, Manfredi Maddalena, Meleti Marco, Fornaini Carlo, Bonanini Mauro, Rocca Ean-Paul, De Moor Roeland J G, Nammour S
Department of ENT/Dental/Ophthalmological and Cervico-Facial Sciences, Università degli Studi di Parma, Via Gramsci 14, 43100 Parma, Italy.
Rev Belge Med Dent (1984). 2009;64(2):87-95.
Reports of cases of ONJ are significantly increased during the last five years as a iatrogenic complication of therapy with bisphosphonates (BPT). The aim of this work is to present the advantages of surgery using Er:YAG laser for treatment of ONJ. Er:YAG laser can gradually reach the healthy bone without causing any heating damage of tissues. This device results very versatile and gives the possibility of choose among different surgical techniques depending by the case (e.g.: vaporization or ostectomy). Moreover, different studies have demonstrated the presence of both bactericidal and biomodulating effect on bone and surrounding tissues, with biostimulation of microcirculation and neoangiogenesis. Seventeen sites of ONJ, classified according to the staging system developed by Ruggiero and observed in 12 patients with multiple myeloma (9 patients), bone metastases (2 patients) and osteoporosis (1 patient), were treated with Er:YAG laser (Fidelis Plus, Fotona-Slovenia). Laser device was used in non-contact or near-contact way (VSP, 300 m3 30 Hz, Fluence 60 J/cm2) on 17 sites (4 Stage I and 13 Stage II) on 3 different types of surgery: sequestrectomy + debridement, sequestrectomy + corticotomy and vaporization. For an average follow-up of 9 months (SD +/- 6 months), complete healing of ONJ (Stage 0) was obtained for 13 sites (76.5%) and resolution of symptoms was obtained (Stage 1) for 3 sites (17.5%). For one site at Stage II (6%), recovery was obtained but this result was not maintained over 3 months. Positive results were independent by the anatomical area (mandible or maxilla), primary disease (osteoporosis, multiple myelomas or metastasis) and discontinuation of BPT before surgery. Er:YAG laser (2940 nm), in our experience, represents a valid therapeutic option for ONJ-BP related, especially in early stages of the disease.
作为双膦酸盐治疗（BPT）的医源性并发症，颌骨坏死（ONJ）病例报告在过去五年中显著增加。这项工作的目的是介绍使用铒激光治疗ONJ的手术优势。铒激光可以逐渐到达健康骨骼，而不会对组织造成任何热损伤。该设备用途广泛，根据具体情况（例如：汽化或骨切除术）可在不同手术技术中进行选择。此外，不同研究表明，其对骨骼和周围组织具有杀菌和生物调节作用，可对微循环和新生血管形成进行生物刺激。对12例患有多发性骨髓瘤（9例）、骨转移（2例）和骨质疏松症（1例）的患者中观察到的17个根据Ruggiero制定的分期系统分类的ONJ部位，使用铒激光（Fidelis Plus，Fotona-斯洛文尼亚）进行治疗。激光设备以非接触或近接触方式（VSP，300 m3 30 Hz，能量密度60 J/cm2）用于17个部位（4个I期和13个II期），采用3种不同类型的手术：死骨切除术+清创术、死骨切除术+皮质切开术和汽化术。平均随访9个月（标准差±6个月），13个部位（76.5%）的ONJ完全愈合（0期），3个部位（17.5%）症状缓解（1期）。对于II期的1个部位（6%），获得了恢复，但该结果在3个月后未维持。阳性结果与解剖区域（下颌骨或上颌骨）、原发性疾病（骨质疏松症、多发性骨髓瘤或转移）以及手术前停用BPT无关。根据我们的经验，铒激光（2940 nm）是与双膦酸盐相关的ONJ的有效治疗选择，尤其是在疾病的早期阶段。
