Department of Dentistry and Oral Surgery, Kansai Medical University, Hirakata 573-1191, Japan.
Department of Oral Health, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8588, Japan.
Int J Environ Res Public Health. 2022 Jun 26;19(13):7854. doi: 10.3390/ijerph19137854.
Recent reports have shown that better treatment outcomes are obtained with surgical therapy in patients with medication-related osteonecrosis of the jaw (MRONJ) than with conservative therapy. However, conservative treatment is selected due to factors such as old age and poor general condition. Conservative therapy aims to relieve symptoms and prevent lesion exacerbation; however, the lesion may expand rapidly in some cases. This study investigated the clinical and imaging findings of 53 MRONJ patients undergoing conservative therapy, and the changes in the clinical findings and the lesion enlargement on CT imaging were examined. Improved clinical findings and no worsening of the imaging findings were considered overall comprehensive treatment successes. Among the 53 patients, the clinical symptoms disappeared or improved in 15 patients, whereas they worsened in 6. In contrast, osteolytic lesion enlargement occurred in 17 patients. The comprehensive treatment outcome of conservative therapy was successful in 12 patients and unsuccessful in 41 patients. The periosteal reaction was significantly correlated with poor comprehensive treatment outcomes ( = 0.038). MRONJ lesions may advance, even if they appear to improve clinically while undergoing conservative treatments. Patients, especially those with periosteal reactions, must be closely followed up with CT examinations, regardless of the clinical findings.
最近的报告表明，对于药物相关性颌骨骨坏死（MRONJ）患者，手术治疗的疗效优于保守治疗。但是，由于年龄较大和一般状况较差等因素，选择了保守治疗。保守治疗旨在缓解症状和防止病变恶化；然而，在某些情况下，病变可能会迅速扩大。本研究调查了 53 例接受保守治疗的 MRONJ 患者的临床和影像学发现，并检查了临床发现的变化和 CT 影像学上的病变扩大情况。如果临床发现改善且影像学发现无恶化，则认为是整体综合治疗成功。在 53 例患者中，15 例患者的临床症状消失或改善，而 6 例患者的症状恶化。相比之下，17 例患者出现溶骨性病变扩大。保守治疗的综合治疗成功率为 12 例，失败率为 41 例。骨膜反应与较差的综合治疗结果显著相关（=0.038）。即使在接受保守治疗时临床症状似乎有所改善，MRONJ 病变也可能会进展。无论临床发现如何，患者，尤其是有骨膜反应的患者，必须密切随访 CT 检查。
