Department of Oral and Maxillofacial Surgery, University of Munich, Munich 80337, Germany.
J Craniomaxillofac Surg. 2012 Oct;40(7):568-71. doi: 10.1016/j.jcms.2011.10.012. Epub 2011 Nov 26.
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious side-effect of bisphosphonate therapy. In the majority of cases BRONJ occurs in the mandible. As a consequence a detailed investigation of BRONJ of the maxilla and in particular of involvement of the maxillary sinus has largely so far been neglected. The aim of this study was to analyse the frequency of maxillary sinusitis and oro-antral fistulae in BRONJ of the maxilla.
A retrospective multicentre analysis was carried out in three Departments of Oral and Maxillofacial Surgery focussing on patients suffering from BRONJ in the maxilla. The role of involvement of the maxillary sinus, in particular sinusitis and oro-antral fistula, was analysed.
Out of a total of 170 patients suffering from BRONJ 53 cases (31.2%) with involvement of the maxilla were identified. At least one sign of maxillary sinusitis was present in 43.6% (23/53) and an oro-antral fistula in the course of the disease was detected in 35.8% (19/53) of those patients. The mean length of time of bisphosphonate intake was 36.16±16.32 months. Zoledronate was most frequently associated (60.4%) with symptoms, followed by the combination of Zoledronate/Ibandronate (13.2%), and Zoledronate/Pamidronate or Pamidronate alone (both 7.5%).
Maxillary sinusitis and oro-antral fistulae are associated with a BRONJ manifestation in the upper jaw in approximately 44%. The involvement of the maxillary sinus should be given special attention and three-dimensional imaging modalities might be necessary, not only to evaluate the extent of necrosis, but also to exclude involvement of the maxillary sinus.
双膦酸盐相关性下颌骨坏死（BRONJ）是双膦酸盐治疗的严重副作用。在大多数情况下，BRONJ 发生在下颌骨。因此，上颌骨 BRONJ 的详细研究，特别是上颌窦的受累，在很大程度上迄今被忽视。本研究旨在分析上颌骨 BRONJ 中上颌窦炎和口鼻瘘的频率。
对三个口腔颌面外科系进行回顾性多中心分析，重点关注上颌骨 BRONJ 患者。分析了上颌窦受累的作用，特别是鼻窦炎和口鼻瘘。
在总共 170 例 BRONJ 患者中，发现 53 例（31.2%）上颌骨受累。在 43.6%（23/53）的患者中存在至少一个上颌窦炎的征象，在 35.8%（19/53）的患者中在病程中检测到口鼻瘘。双膦酸盐摄入的平均时间为 36.16±16.32 个月。唑来膦酸最常与症状相关（60.4%），其次是唑来膦酸/伊班膦酸盐（13.2%），以及唑来膦酸/帕米膦酸盐或帕米膦酸盐单独使用（均为 7.5%）。
上颌窦炎和口鼻瘘与上颌骨 BRONJ 表现相关，约占 44%。上颌窦受累应给予特别关注，可能需要三维成像方式，不仅要评估坏死的程度，还要排除上颌窦的受累。
