Curi Marcos Martins, Cossolin Giuliano Saraceni Issa, Koga Daniel Henrique, Zardetto Cristina, Christianini Silmara, Feher Olavo, Cardoso Camila Lopes, dos Santos Marcelo Oliveira
Department of Stomatology, Hospital Santa Catarina, São Paulo, Brazil.
J Oral Maxillofac Surg. 2011 Sep;69(9):2465-72. doi: 10.1016/j.joms.2011.02.078. Epub 2011 Jul 16.
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-recognized pathologic entity that is challenging and difficult to manage. Recent literature contains several articles, with most recommending conservative management. This report describes a treatment modality for advanced cases of BRONJ that involves bone resection and autologous platelet-rich plasma (PRP).
This case series consisted of 25 patients with BRONJ lesions and a history of intravenous bisphosphonate therapy for metastatic bone diseases that did not respond to conservative treatment. All patients were surgically managed by a standardized protocol combining bone resection and PRP.
Of the 25 patients, 20 (80%) showed complete wound healing during follow-up. Median follow-up was 36 months. Microscopic examination showed actinomyces in 15 specimens.
BRONJ has been shown to be refractory to conservative management. Treatment of refractory BRONJ with a combination of bone resection and PRP was found to be an effective therapy in most patients and should be considered an alternative treatment modality for management of advanced cases.
双膦酸盐相关颌骨坏死（BRONJ）是一种公认的病理实体，具有挑战性且难以处理。近期文献中有几篇文章，大多数推荐保守治疗。本报告描述了一种针对晚期BRONJ病例的治疗方式，包括骨切除和自体富血小板血浆（PRP）。
该病例系列包括25例患有BRONJ病变且有静脉注射双膦酸盐治疗转移性骨病病史、对保守治疗无反应的患者。所有患者均通过结合骨切除和PRP的标准化方案进行手术治疗。
25例患者中，20例（80%）在随访期间伤口完全愈合。中位随访时间为36个月。显微镜检查显示15个标本中有放线菌。
BRONJ已被证明对保守治疗无效。发现骨切除和PRP联合治疗难治性BRONJ对大多数患者是一种有效的治疗方法，应被视为晚期病例管理的一种替代治疗方式。
