Department of Oral and Maxillofacial Surgery, Masaryk University-Faculty of Medicine and University Hospital Brno, Brno, Czech Republic.
Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic.
Ear Nose Throat J. 2024 May;103(5):277-281. doi: 10.1177/01455613211053389. Epub 2021 Oct 21.
Antiresorptive drugs are widely used to reduce bone mineral loss in patients with osteoporosis and to prevent skeletal-related events in patients with metastatic cancers and multiple myeloma (MM). Both the bisphosphonates (BP) and denosumab typically used in this indication were shown to be effective and relatively safe. Obviously, this medication could have some adverse effects; one of them is osteonecrosis of the external auditory canal. Only sporadic cases of external auditory canal osteonecrosis have been published yet. Here, we provide a case of denosumab-related osteonecrosis of the external auditory canal successfully treated surgically in the early stage of the disease. A 68-year-old patient with breast cancer underwent comprehensive oncological treatment, including denosumab administration. She was diagnosed with osteonecroses in the jaw and ear canal. The necrotic bones in both regions were resected with primary wound closure. Both affected sites healed well with no signs of necrosis recurrence. Osteonecrosis of the external auditory canal is a rare but probably underdiagnosed complication of antiresorptive medication. It has a negative impact on patient quality of life if left untreated. Early surgical treatment appears to be effective. The authors highlight several similarities with medication-related osteonecrosis of the jaw. Therefore, an analogous disease staging and treatment rationale is suggested.
抗吸收药物被广泛用于减少骨质疏松症患者的骨矿物质流失，并预防转移性癌症和多发性骨髓瘤（MM）患者的骨骼相关事件。在该适应证中通常使用的双膦酸盐（BP）和地舒单抗均被证明是有效且相对安全的。显然，这种药物可能会有一些不良反应；其中之一是外耳道口骨坏死。然而，目前仅有少数外耳道口骨坏死的病例被报道。在这里，我们提供了一个早期经手术成功治疗的地舒单抗相关性外耳道口骨坏死的病例。一名 68 岁的乳腺癌患者接受了包括地舒单抗给药在内的全面肿瘤治疗。她被诊断为颌骨和耳道骨坏死。在两个区域切除了坏死的骨头，并进行了一期伤口闭合。两个受累部位均愈合良好，无坏死复发迹象。外耳道口骨坏死是一种罕见但可能被低估的抗吸收药物的并发症。如果不治疗，会对患者的生活质量产生负面影响。早期手术治疗似乎是有效的。作者强调了与药物相关性颌骨骨坏死的几个相似之处，因此建议采用类似的疾病分期和治疗方案。
