Giovannacci Ilaria, Meleti Marco, Corradi Domenico, Vescovi Paolo
Resident, Department of Biomedical, Biotechnological and Translational Sciences, Center of Oral Medicine and Laser Surgery, University of Parma, Parma, Italy.
Professor, Department of Biomedical, Biotechnological and Translational Sciences, Center of Oral Medicine and Laser Surgery, University of Parma, Parma, Italy.
J Oral Maxillofac Surg. 2017 Jun;75(6):1216-1222. doi: 10.1016/j.joms.2016.12.011. Epub 2016 Dec 15.
Medication-related osteonecrosis of the jaws (MRONJ) is an adverse side effect of several drug therapies, including bisphosphonates (BPs). Osteonecrosis of the jaw specifically related to BP therapy is usually referred to using the acronym BRONJ. However, no consensus has yet been reached regarding the most appropriate management of BRONJ. The greatest success rates have been recorded with surgical removal of necrotic bone. In particular, erbium:yttrium-aluminum-garnet (Er:YAG) laser-assisted surgery has shown significantly better results than conventional surgical approaches. According to a position paper reported by the American Association of Oral and Maxillofacial Surgeons in 2007, the identification of necrotic bone margins during osteonecrosis removal can be very difficult. In 2015, a review of treatment perspectives for MRONJ reported that both surgical debridement and resection cannot be standardized owing to the lack of guidance to define the necrotic margins. Recently, the use of autofluorescence (AF) of the bone as a possible suitable guide to visualize necrotic bone during surgical debridement or resection was proposed. It seems that vital bone could be highlighted by its very strong AF. In contrast, necrotic bone loses AF and, thus, appears much darker. The molecular sources of the phenomenon of AF are the specific amino acids of the collagen molecules that show AF when irradiated by ultraviolet or blue light. The use of AF as an intraoperative diagnostic tool is entirely new in the management of MRONJ, although it has been used for several years in other fields (eg, intervertebral disc surgery). The aim of the present report was to describe a case of mandibular BRONJ treated with a new surgical approach performed with an Er:YAG laser and guided by AF. The histopathologic evaluation of the removed hypofluorescent bone block and hyperfluorescent surrounding bone has also been reported in detail.
药物相关性颌骨坏死（MRONJ）是包括双膦酸盐（BP）在内的几种药物治疗的不良副作用。与BP治疗具体相关的颌骨坏死通常使用首字母缩写词BRONJ来指代。然而，关于BRONJ的最佳治疗方法尚未达成共识。手术切除坏死骨的成功率最高。特别是，铒：钇铝石榴石（Er：YAG）激光辅助手术已显示出比传统手术方法明显更好的效果。根据美国口腔颌面外科医师协会2007年报告的一份立场文件，在坏死骨切除过程中确定坏死骨边缘可能非常困难。2015年，一项关于MRONJ治疗前景的综述报告称，由于缺乏定义坏死边缘的指导，手术清创和切除都无法标准化。最近，有人提出利用骨的自体荧光（AF）作为在手术清创或切除过程中可视化坏死骨的一种可能合适的指导。似乎活骨因其非常强的AF而突出显示。相比之下，坏死骨失去AF，因此显得暗得多。AF现象的分子来源是胶原蛋白分子的特定氨基酸，当受到紫外线或蓝光照射时会显示AF。AF作为术中诊断工具在MRONJ的治疗中是全新的，尽管它在其他领域（如椎间盘手术）已经使用了数年。本报告的目的是描述一例采用Er：YAG激光并在AF引导下进行的新手术方法治疗的下颌骨BRONJ病例。还详细报告了切除的低荧光骨块和高荧光周围骨的组织病理学评估。
