Aghaloo Tara L, Dry Sarah M, Mallya Sanjay, Tetradis Sotirios
Associate Professor, Division of Diagnostic and Surgical Sciences, University of California-Los Angeles School of Dentistry, Los Angeles, CA.
Professor, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, CA.
J Oral Maxillofac Surg. 2014 Apr;72(4):702-16. doi: 10.1016/j.joms.2013.09.008. Epub 2014 Jan 4.
Osteonecrosis of the jaws (ONJ) is a complex disease involving multiple tissue and cell-type responses to wound healing or infection. AAOMS defines bisphosphonate related ONJ (BRONJ) as exposed, necrotic bone in the maxillofacial region that has persisted for more than 8 weeks in a patient with current or previous antiresorptive treatment, without a history of radiation therapy to the jaws. Since the first reported ONJ cases in 2003 and 2004, there has been little advancement in understanding the etiology and pathophysiology of ONJ. Many hypotheses have been proposed, including bisphosphonate (BP) toxicity to oral epithelium, altered wound healing after tooth extraction, high turnover of the mandible and maxilla, oral biofilm formation, infection and inflammation, and suppression of angiogenesis and bone turnover. The current classification system of ONJ involves stages 0 to 3 and is based on patient clinical presentation. This report describes a case of stage 0 ONJ in a patient on denosumab and indicates the full-spectrum similarities between BP- and denosumab-associated ONJ clinically, radiographically, and histologically.
颌骨骨坏死（ONJ）是一种复杂的疾病，涉及多种组织和细胞类型对伤口愈合或感染的反应。美国口腔颌面外科医师协会（AAOMS）将双膦酸盐相关颌骨骨坏死（BRONJ）定义为：在接受过当前或既往抗吸收治疗的患者中，颌面部区域暴露的坏死骨持续超过8周，且无颌骨放射治疗史。自2003年和2004年首次报道ONJ病例以来，在理解ONJ的病因和病理生理学方面进展甚微。已经提出了许多假说，包括双膦酸盐（BP）对口腔上皮的毒性、拔牙后伤口愈合改变、下颌骨和上颌骨的高周转率、口腔生物膜形成、感染和炎症，以及血管生成和骨转换的抑制。目前ONJ的分类系统包括0至3期，基于患者的临床表现。本报告描述了1例使用地诺单抗的患者发生0期ONJ的病例，并指出了BP相关和地诺单抗相关ONJ在临床、影像学和组织学上的全面相似性。
