Clinical Lecturer, University of Manchester Division of Dentistry, School of Medical Sciences, Oral Surgery Department, Manchester, UK; Clinical Teacher, King's College Hospital, Oral Surgery Department, London, UK.
Dental Core Trainee, Northwick Park Hospital - London North West University Healthcare NHS Trust, Oral and Maxillofacial Surgery Department, London, UK.
Br J Oral Maxillofac Surg. 2022 Feb;60(2):e216-e230. doi: 10.1016/j.bjoms.2021.03.006. Epub 2021 Mar 24.
Osteonecrosis of the jaw is a severe adverse condition affecting patients exposed to specific types of medications. Previous studies have highlighted that osteonecrosis of the jaw is triggered by invasive dental procedures and can be very challenging to manage, especially in patients with cancer. The primary aim of this review was to analyse all available evidence on the management (surgical and/or conservative) of medication related osteonecrosis of the jaws (MRONJ) in patients with a history of antiangiogenic drugs therapy and who had not been previously exposed to any antiresorptive drug treatments. A multi-database search (PubMed, MEDLINE, EMBASE and CINAHL) was performed to identify related multi-language papers published from January 2003 until November 2020. Data were extracted from relevant papers and analysed according to the outcomes selected in this review. The search generated 28 studies eligible for the analysis. The total number of patients included in the analysis was 36. Sixteen patients were treated with anti-vascular endothelial growth factor drugs (anti-VEGF) while the remaining patients were administered a combination of antiangiogenic drugs. The most common MRONJ site was the mandible in 29 patients. MRONJ recurrence after treatment was only reported in six patients, the majority of which were treated conservatively. The data reviewed confirmed that an invasive procedure was the most common trigger of MRONJ with relatively high frequency of postoperative recurrence following treatment. However, due to the low quality of available research in the literature, it is difficult to draw a definitive conclusion on the validity of the presented treatment to manage patients affected by MRONJ associated with angiogenic therapy.
颌骨坏死是一种严重的不良状况，影响接受特定类型药物治疗的患者。先前的研究表明，颌骨坏死是由侵入性牙科手术引发的，并且很难治疗，尤其是在癌症患者中。本综述的主要目的是分析所有关于接受过抗血管生成药物治疗但以前未接受过任何抗吸收药物治疗的患者中，与药物相关的颌骨坏死（MRONJ）的管理（手术和/或保守）的所有可用证据。通过多数据库搜索（PubMed、MEDLINE、EMBASE 和 CINAHL），以确定 2003 年 1 月至 2020 年 11 月期间发表的相关多语言论文。从相关论文中提取数据，并根据本综述中选择的结果进行分析。该搜索生成了 28 项符合分析条件的研究。分析中纳入的患者总数为 36 例。16 例患者接受了抗血管内皮生长因子药物（anti-VEGF）治疗，而其余患者接受了抗血管生成药物联合治疗。最常见的 MRONJ 部位是 29 例下颌骨。仅报告了 6 例治疗后 MRONJ 复发，其中大多数患者接受了保守治疗。回顾的数据证实，侵入性手术是 MRONJ 最常见的诱因，治疗后术后复发的频率相对较高。然而，由于文献中可用研究的质量较低，因此难以对所提出的治疗方法的有效性得出明确结论，以管理受血管生成治疗相关的 MRONJ 影响的患者。
