Department of Interdisciplinary Medicine, Complex Operating Unit of Odontostomatology, Aldo Moro University, Bari, Italy.
Department of Emergency and Organ Transplantation, Operating Unit of Pathological Anatomy, Aldo Moro University, Bari, Italy.
Oral Dis. 2018 Mar;24(1-2):238-242. doi: 10.1111/odi.12764.
Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect of antiresorptive (bisphosphonates and denosumab) and anti-angiogenic therapy used in the management of oncologic and, less frequently, osteoporotic patients. While there is good international agreement on the diagnostic and staging criteria of MRONJ and the cessation of antiresorptive/anti-angiogenic treatments, the gold standard of treatment is still controversial, in particular between non-surgical and surgical approaches. The former usually includes antiseptic mouth rinse, cyclic antibiotic therapy, low-level laser therapy and periodic dental checks; the latter consists of surgical necrotic bone removal. The purpose of this retrospective study was to describe the therapeutic approaches and outcomes of 131 lesions from 106 MRONJ patients treated at the Policlinic of Bari. Non-surgical treatments were chosen for 24 lesions that occurred in 21 patients who, due to comorbidities and/or the impossibility of stopping oncologic therapies, could not undergo surgical treatment. As to the outcome, all the surgically treated lesions (107) showed complete healing, with the exception of 13.5% of the lesions, all of which were stage III, which did not completely heal but showed reduction to stage I. The 24 non-surgically treated lesions never completely healed and, rather, generally remained stable. Only two cases exhibited a reduction in staging. Based on our observations, MRONJ occurring both in neoplastic and non-neoplastic patients benefits more from a surgical treatment approach, whenever deemed possible, as non-surgical treatments do not seem to allow complete healing of the lesions.
药物相关性颌骨坏死(MRONJ)是一种严重的副作用,发生于接受抗吸收(双磷酸盐和地舒单抗)和抗血管生成治疗的肿瘤患者,以及较少见的骨质疏松症患者。尽管国际上对 MRONJ 的诊断和分期标准以及停止抗吸收/抗血管生成治疗达成了共识,但治疗的金标准仍存在争议,特别是在非手术和手术方法之间。前者通常包括防腐漱口液、周期性抗生素治疗、低水平激光治疗和定期牙科检查;后者包括手术性坏死骨切除。本回顾性研究的目的是描述在巴里综合医院治疗的 106 例 MRONJ 患者的 131 个病变的治疗方法和结果。21 例患者的 24 个病变选择了非手术治疗,这些患者由于合并症和/或不能停止肿瘤治疗,不能进行手术治疗。关于结果,所有手术治疗的病变(107 个)均完全愈合,除了所有处于 III 期的病变,这些病变均未完全愈合,但降期至 I 期。24 个非手术治疗的病变从未完全愈合,而且通常保持稳定。只有两例病变降期。根据我们的观察,在肿瘤和非肿瘤患者中发生的 MRONJ 从手术治疗方法中获益更多,只要认为可行,因为非手术治疗似乎不能使病变完全愈合。