25例双膦酸盐相关颌骨坏死病例分析

Bisphosphonate-related osteonecrosis of the jaw: a report of 25 cases

目的总结双膦酸盐相关颌骨坏死（bisphosphonate-related osteonecrosis of the jaw,BRONJ）病例的临床及X线特点。方法对25例临床诊断为BRONJ患者的临床和X线资料进行回顾性分析。结果 25例患者中女性12例,男性13例,年龄35~81岁;其中23例曾患恶性肿瘤,另2例为骨质疏松症。临床表现多为患区反复肿痛、流脓和牙齿松动。25例共存在31个病灶。所有患者的X线表现均有颌骨密度改变。其中9处颌骨病变仅表现为骨密度改变而未形成死骨,为早期病变;其它X线表现包括死骨形成（22个）、牙槽窝不愈（17个）和骨膜反应（10个）。结论 BRONJ早期X线表现为颌骨密度改变和线状骨膜反应,晚期可形成死骨,常累及多个象限。

Objective To summarize the clinical and radiographic features of bisphosphonate-related osteonecrosis of the jaw（BRONJ）. Methods Clinical data and radiographic findings of 25 patients with BRONJ were analyzed in the retrospective study. Radiographic imagine included panoramic radiograph, computed tomography（CT）,and/or cone beam computed tomography（CBCT）. Results Among the 25 patients, 12 were female and 13 were male（aged 35-81 years）. 23 patients were diagnosed with malignant tumor and 15 patients of them presenting with bone metastasis, two patients were diagnosed with osteoporosis. Breast cancer was the most common primary tumor（7/25）. 23 patients with malignant tumor and one patient with osteoporosis were given intravenous bisphosphonates while the other one with osteoporosis was given oral administration. Bisphosphonates treatment duration was ranged from 6 months to 7years for intravenous administration and 3 years for oral administration. Clinical symptoms and signs included localized pain, soft tissue swelling, suppuration, loose tooth, and bone exposure. 15 patients had a history of tooth extraction. All 25 patients had involvement of the maxilla（n=10）, the mandible（n=10）, or both mandible and maxilla（n=5）. Altogether31 jaw lesions were analyzed. All patients demonstrated structure alteration of trabecular bone on radiographs. Other radiographic findings included persistent tooth sockets（17 cases）, sequestration（22 lesions）, and periosteal reaction（10lesions）. Radiographic findings of structure alteration of trabecular bone without sequestration were defined as early stage lesions（9 lesions）. Among them, 4 lesions showed periosteal reaction. Maxillary sinus was affected in 12 lesions involving the maxilla. Conclusion Radiographic findings of early stage lesions were structure alteration of trabecular bone and linear periosteal reaction. Sequestration was found in advanced stage. More than one quarter of the jaws could be affected.