Section of Oral and Maxillofacial Surgery, Department of Surgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Oral Oncol. 2011 May;47(5):420-4. doi: 10.1016/j.oraloncology.2011.02.024. Epub 2011 Mar 24.
Surgical treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is controversial. Current recommendations contraindicate aggressive surgery because its results are unpredictable and may trigger disease progression. In this prospective study, we assessed the effectiveness of surgical resection of the jaws in cancer patients with BRONJ. Between June 2004 and July 2009, 30 cancer patients with refractory BRONJ underwent surgical resection of the jaws at our Units. They were followed-up weekly for the first month, at 3-month intervals up to 1 year, and at 6-month intervals up to 2 years. Panoramic radiographs and CT-scan were obtained at 3, 6, 12, 18 and 24 months. Primary outcomes were the 24-month recurrence rate of BRONJ and the 24-month mortality rate. Secondary outcomes were post-operative complications, duration of hospital stay after surgery, time to return to oral diet, and degree of oral pain. The 30 patients had a median age of 66 years and were mostly females (80%). Twenty-eight underwent a single resection and two had both jaws resected, for a total of 32 resected jaws. The cumulative recurrence rate of BRONJ in resected jaws 3.1% and 9.4% at 3 and 6 months, respectively. All the jaws with recurrent BRONJ had osteomyelitis at the margins of bone resection. The cumulative incidence of death was 3%, 12% and 16% at 12, 18 and 24 months. Surgical resection of BRONJ was highly effective, with few post-operative complications and were not associated with long-term mortality.
手术治疗双膦酸盐相关性颌骨骨坏死（BRONJ）存在争议。目前的建议禁忌积极手术，因为其结果不可预测，并且可能引发疾病进展。在这项前瞻性研究中，我们评估了手术切除颌骨在癌症伴 BRONJ 患者中的有效性。2004 年 6 月至 2009 年 7 月期间，我们单位对 30 例难治性 BRONJ 癌症患者进行了颌骨手术切除。术后 1 个月每周随访 1 次，第 1 年每 3 个月随访 1 次，第 2 年每 6 个月随访 1 次。在第 3、6、12、18 和 24 个月时获取全景 X 线和 CT 扫描。主要结局是 BRONJ 的 24 个月复发率和 24 个月死亡率。次要结局是术后并发症、手术后住院时间、恢复口腔饮食的时间和口腔疼痛程度。30 例患者的中位年龄为 66 岁，大多数为女性（80%）。28 例患者接受了单次切除，2 例患者接受了双侧颌骨切除，共切除了 32 个颌骨。切除颌骨的 BRONJ 累积复发率分别为 3 个月时 3.1%和 6 个月时 9.4%。所有复发 BRONJ 的颌骨均有骨切除边缘骨髓炎。12、18 和 24 个月时的死亡率分别为 3%、12%和 16%。BRONJ 的手术切除非常有效，术后并发症少，与长期死亡率无关。
