Fatema Chowdhury Nusrat, Sato Jun, Yamazaki Yutaka, Hata Hironobu, Hattori Naoya, Shiga Tohru, Tamaki Nagara, Kitagawa Yoshimasa
Division of Oral Pathobiological Science, Department of Oral Diagnosis and Medicine, Graduate School of Dental Medicine, Hokkaido University, Kita 13 Nishi 7, Kita-ku, Sapporo, 060-8586, Japan,
Odontology. 2015 Jan;103(1):105-8. doi: 10.1007/s10266-013-0129-y. Epub 2013 Aug 2.
We report an advanced case of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in an osteoporotic patient treated with oral risedronate sodium for 2 years. An 80-year-old woman presented to our hospital complaining of pain, swelling and pus discharge in the lower alveolar ridge. Fluorine-18 labeled fluorodeoxyglucose positron emission tomography (FDG-PET) and bone scintigraphy showed definite uptake in the mandible. Under clinical diagnosis of BRONJ, we applied systematic treatments including antibiotic therapy, irrigation, cessation of bisphosphonate, hyperbaric oxygen (HBO) therapy, and debridement of necrotic bone. After pre-operative 20 sessions of HBO therapy, her clinical symptoms disappeared. SUVmax of FDG-PET decreased definitely from 4.5 to 2.5, although magnetic resonance image and bone scintigraphy did not show remarkable changes. After minor surgery with debridement of necrotic bone, she received another ten sessions of HBO therapy. After the treatment, her clinical course was excellent. In conclusion, this report demonstrates FDG-PET may predict the effect of HBO therapy in BRONJ.
我们报告了一例骨质疏松患者在口服利塞膦酸钠治疗2年后发生双膦酸盐相关颌骨坏死（BRONJ）的进展期病例。一名80岁女性因下牙槽嵴疼痛、肿胀和流脓前来我院就诊。氟-18标记的氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）和骨闪烁显像显示下颌骨有明确摄取。在临床诊断为BRONJ后，我们采用了包括抗生素治疗、冲洗、停用双膦酸盐、高压氧（HBO）治疗以及坏死骨清创在内的系统治疗方法。术前进行20次HBO治疗后，她的临床症状消失。尽管磁共振成像和骨闪烁显像未显示明显变化，但FDG-PET的最大标准摄取值（SUVmax）从4.5明显降至2.5。在进行坏死骨清创的小手术后，她又接受了10次HBO治疗。治疗后，她的临床病程良好。总之，本报告表明FDG-PET可能预测HBO治疗BRONJ的效果。
