双侧上颌骨二膦酸盐颌骨坏死1例报道

Bilateral maxillary bisphosphonate-related osteonecrosis of the jaw:a case report

二膦酸盐类（bisphosphonates,BP）药物作为一种强效骨吸收抑制剂已用于临床30余年,广泛用于控制与骨代谢改变相关的疾病,如：骨质疏松症、恶性肿瘤骨转移、恶性肿瘤引起的高钙血症、多发性骨髓瘤和Paget骨病。自2003年Marx-（[1]）首次报道二膦酸盐类药物可导致颌骨坏死的现象以来,相关病例报道逐渐增多。

Bisphosphonate-related osteonecrosis of the jaw（ BRONJ）,as one serious side-effect of bisphosphonate therapy,has been known for more than ten years since it was first reported in 2003. In the majority of the cases,BRONJ occurs more commonly in the mandible. Those involving the maxilla are relatively few. This paper reported a case that a patient with multiple myeloma developed bilateral maxillary BRONJ after tooth extraction. The patient had used bisphosphonates for more than three years,meanwhile with uncontrolled diabetes mellitus. The patient recovered completely after surgical treatment,in combination with diabetes disease control and antibiotics application. Two key factors to ensure the success of surgical treatment are as follows： sufficient removal of infected and necrotic tissue,and good blood-supply for the local flap to help completely close the wound. The literature was reviewed to analyze the reasons why bone necrosis related to bisphosphonates was most likely to occur in the jaw,especially in the mandible,according to the pathogenesis of this disease. Furthermore,the related risk factors of BRONJ presented in this case were discussed,such as tooth extraction,oral infection and diabetes mellitus,etc. We summarized adjuvant prophylaxes for prevention of BRONJ after tooth extraction,for example,drug holiday that could be used in the dental clinic. This case report reminds us that it＇s of great importance to establish the awareness that the osteonecrosis of the jaw may be related to the use of some bone-stabilizers. As for patients with a history of exposure to antiresorptive or antiangiogenic agents,dentists are supposed to be cautious. It＇s recommended to take appropriate measures in perioperative period of oral surgical treatment to prevent BRONJ.