Department of Oral and Maxillofacial Surgery, University Hospital and Faculty of Medicine in Pilsen, Charles University in Prague, Alej Svobody 80, 304 60 Pilsen, Czech Republic.
Clinic of Ophthalmology, University Hospital and Faculty of Medicine in Pilsen, Charles University in Prague, Alej Svobody 80, 304 60 Pilsen, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2020 Mar;164(1):100-107. doi: 10.5507/bp.2018.081. Epub 2019 Jan 10.
Medication - related osteonecrosis of the jaw (MRONJ) is a rare but serious complication of antiresorptive and/or antiangiogenic therapy. It mainly affects oncological patients, however, it can occur in patients with metabolic bone diseases, although this is less frequent. These lesions not only significantly impair the quality of life but can also have impact on the treatment of any underlying disease. In some rare cases MRONJ can be life-threatening. There is still no ideal consensus for treatment, though surgical therapy has been mostly preferred in recent years.
A monocentric retrospective evaluation of surgical therapy of MRONJ in osteoporotic patients, treated in the time period 3/2014-3/2018 using the uniform department-specific protocol.
26 osteoporotic patients with 32 MRONJ lesions of stage 1 (9%), stage 2 (75%) and stage 3 (16%) were treated surgically. The maxilla: mandibula ratio was 1:2.2, in 19% of patients there was multiple jaw involvement. 69.2% of patients had received bisphosphonates, 15.4% denosumab and 15.4% had a history of both types of antiresorptive treatment. Complete healing was observed in all patients, in 9% of cases by secondary intention in the mean period of 6 weeks. The mean follow-up was 20.5 months.
The presented protocol for surgical therapy was effective in the management of all MRONJ stages in the osteoporotic patients described here. The surgery is indicated as an early treatment to prevent complications and the progression of the lesions. It leads to improvement in quality of life and option to resume antiresorptive therapy if interrupted.
药物相关性颌骨坏死（MRONJ）是一种罕见但严重的抗吸收和/或抗血管生成治疗相关并发症。它主要影响肿瘤患者，但也可发生在代谢性骨病患者中，尽管这种情况较少见。这些病变不仅显著降低了生活质量，还可能影响任何基础疾病的治疗。在一些罕见的情况下，MRONJ 可能危及生命。尽管近年来手术治疗已成为首选，但仍没有理想的治疗共识。
对 2014 年 3 月至 2018 年 3 月期间，使用统一的部门特定方案，对骨质疏松患者的 MRONJ 进行手术治疗的单中心回顾性评估。
26 例骨质疏松患者，32 处 MRONJ 病变，分期为 1 期（9%）、2 期（75%）和 3 期（16%）。上颌骨：下颌骨比例为 1:2.2，19%的患者有多处颌骨受累。69.2%的患者接受过双膦酸盐治疗，15.4%的患者接受过地舒单抗治疗，15.4%的患者接受过两种类型的抗吸收治疗。所有患者均完全愈合，9%的患者通过二期愈合，平均愈合时间为 6 周。平均随访时间为 20.5 个月。
本研究报告的手术治疗方案对所描述的骨质疏松患者的所有 MRONJ 分期均有效。手术是一种早期治疗方法，可预防并发症和病变进展。它可提高生活质量，并在中断抗吸收治疗时恢复该治疗。
