Suzuki Taiki, Sekiya Ryo, Hamada Yuji, Takahashi Miho, Karakida Kazunari, Sakamoto Haruo
Department of Oral and Maxillofacial Surgery, Hachioji Hospital Tokai University.
Department of Oral Medicine, Oral and Maxillofacial Surgery, Tokyo Dental College.
Bull Tokyo Dent Coll. 2018;59(1):27-34. doi: 10.2209/tdcpublication.2016-0052.
Here, we report a case of fatal bleeding in conjunction with mandibular medicationrelated osteonecrosis of the jaw (MRONJ). A 75-year-old Japanese man was referred to our department with osteonecrosis of the jaw due to bisphosphonate (BP) for multiple bone metastases from prostate cancer. Aggressive surgical intervention was ruled out due to a poor prognosis in terms of life expectancy. Death occurred due to hemorrhagic shock resulting from massive oral bleeding caused by necrosis of the mandible. Numerous reports have suggested that jaw necrosis is induced not only by BP, but also RANKL antibody, steroids, and molecularly-targeted agents. This suggests that the number of cases of MRONJ is likely to increase among elderly patients in whom general health is already poor. The American Association of Oral and Maxillofacial Surgery recommends aggressive treatment only in cases of stage 3 disease. Therefore, such a therapeutic strategy may only be available for cases of jaw necrosis in which the general health status of the patient is otherwise good. To prevent a life-threatening outcome in cases of MRONJ, physicians, who are responsible for determining the drug strategy, should cooperate with oral surgeons in determining the best therapeutic strategy.
在此，我们报告一例与下颌骨药物相关性骨坏死（MRONJ）相关的致命性出血病例。一名75岁的日本男性因前列腺癌多发骨转移接受双膦酸盐（BP）治疗后出现颌骨坏死，被转诊至我科。由于预期寿命预后不佳，排除了积极的手术干预。患者因下颌骨坏死导致大量口腔出血，进而引发失血性休克死亡。众多报告表明，颌骨坏死不仅由BP引起，还可由RANKL抗体、类固醇和分子靶向药物诱发。这表明，在健康状况本就较差的老年患者中，MRONJ的病例数可能会增加。美国口腔颌面外科协会建议仅在3期疾病的病例中进行积极治疗。因此，这种治疗策略可能仅适用于患者总体健康状况良好的颌骨坏死病例。为防止MRONJ病例出现危及生命的后果，负责确定药物治疗策略的医生应与口腔外科医生合作，以确定最佳治疗策略。
