双膦酸盐类药物相关上颌骨坏死

Bisphosphonates associated osteonecrosis of the maxilla

1例59岁男性患者因食管癌骨转移给予唑来膦酸4mg静脉滴注、1次／月。用药11次后患者出现牙龈脓肿，停用唑来膦酸，行口内脓肿切开引流术、脓肿冲洗及抗感染治疗后好转。其后改用帕米膦酸二钠80mg静脉滴注、1次／月，共用药8次。末次给药后1个月患者于拔牙后出现局部创口溢脓、疼痛，间断发热，可见暴露骨面和瘘管形成。停用帕米膦酸二钠，行右上颌骨感染病灶清除术及骨隆突修整术，并给予全身和局部抗感染治疗，4个月后创面愈合。考虑为双膦酸盐类药物相关上颌骨坏死。

A 59-year-old male patient received intravenous infusion of zoledronic acid 4 mg once a month because of esophageal cancer with bone metastasis. After 11 times of treatments, the patient developed parulis. Zoledronic acid was stopped. Then he was improved after abscess incision, irrigation drainage, and anti-infective treatments. Then an intravenous infusion of pamidronate 80 mg once a month was given. A total of 8 times of treatments were given and about 1 month after the last treatment, he developed pus and pain in local wounds, intermittent fever, and visible bone exposure and fistula formation after tooth extraction operation. Pamidronate was stopped, infected focal lesion of maxilla was cleared, his bone carinal was repaired, and systemic and local anti-infection treatments were given. Four months later, his wound was healed. Bisphosphonates associated osteonecrosis of maxilla was considered.