Abstract
Medikasyon ile ilişkili çene osteonekrozu (MRONJ); radyoterapi hikayesi olmayan, antianjiogenik veya antirezorptif ilaç
kullanan hastalarda maksillofasiyal bölgede 8 haftadan uzun süre var olan ekspoze ve nekrotik kemik varlığında ortaya çıkan durumdur. Bu vaka raporunda; IV (intravenöz) bifosfonat kullanan hastada diş çekimine bağlı oluşan maksiller çene osteonekrozunun oral pentoksifilin ve alfa tokoferol kullanımını takiben nekroz alanının cerrahi olarak çıkartılması sonrası oluşan iyileşmeyi göstermek amaçlanmaktadır.
80 yaşındaki kadın hasta 2011 yılında tanısı konulan osteoporozdan dolayı aynı yıldan itibaren düzenli olarak IV bifosfonat (zoledronik asit, ibandronik asit, alendronat sodyum) kullanmaktadır. 2021 yılında dış merkezde çektirdiği 23 numaralı dişe bağlı olarak gelişen sol üst çenedeki osteonekroz nedeniyle 2021 yılında Akdeniz Üniversitesi Diş Hekimliği Fakültesi Ağız Diş ve Çene Cerrahisi kliniğine başvurmuştur. Hastaya 2 ay süre boyunca pentoksifilin ve alfa tokoferol medikal tedavisi uygulandı. İlaç kullanımını takiben nekroz alanları içeren geniş rezeksiyon yapılıp iyileşme sağlandı.
Pentoksifilin ve alfa tokoferol medikal tedavisi, MRONJ tedavisinde etkin bir destek yaklaşımdır.
Keywords
References
- 1. Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, et al. American Association of Oral and Maxillofacial Surgeons position paper on medicationrelated osteonecrosis of the jaw-2014 update. J Oral Maxillofac Surg. 2014;72:1938. 2. Wood J, Bonjean K, Ruetz S, Ballahcene A, Devy L, Foidart JM. Novel antiangiogenic effects of the bisphosphonate compound zoledronic acid. J Pharmacol Exp Ther. 2002;302:1055-61.
- 3. Santini D, Vincenzi B, Avvisati G, Dicuonzo G, Salerno A, Denaro V. Pamidronate ınduces modifications of circulating angiogenic factors in cancer patients. Clin Cancer Res. 2002; 8:1080-4
- 4. Stepan JJ, Alenfeld F, Boivin G, Feyen JH, Lakatos P. Mechanisms of action of antiresorptive therapies of postmenopausal osteoporosis. Endocr Regul. 2003;37:225-38.
- 5. Mohamed HAM, Nielsen CEN, Schiodt M. Medication related osteonecrosis of the jaws associated with targeted therapy as monotherapy and in combination with antiresorptives. A report of 7 cases from the Copenhagen Cohort. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018;125:157-63.
- 6. Li J, Wang W. Positive effect of pentoxifylline on medication-related osteonecrosis of the jaw. Journal of Stomatology, Oral Maxillofac Surg. 2020;121:264-7.
- 7. Otto S, Abu-Id MH, Fedele S, Warnke PH, Becker ST, Kolk A, et al. Osteoporosis and bisphosphonates-related osteonecrosis of the jaw: not just a sporadic coincidence–a multi-centre study. J Cranio-Maxillofac Surg. 2011;39:272-7.
- 8. Delanian S, Depondt J, Lefaix JL. Major healing of refractory mandible osteoradionecrosis after treatment combining pentoxifylline and tocopherol: a phase II trial. Head Neck 2005;27:114-23.
- 9. Delanian S, Chatel C, Porcher R, Depondt J, Lefaix J. Complete restoration of refractory mandibular osteoradionecrosis by prolonged treatment with a pentoxifylline-tocopherol-clodronate combination (PENTOCLO): A phase II trial. Int J Radiat Oncol Biol Phys. 2011;80:832-9.
- 10. Epstein MS, Wicknick FW, Epstein JB, Berenson JR, Gorsky M. Management of bisphosphonate-associated osteonecrosis: Pentoxifylline and tocopherol in addition to antimicrobial therapy. An initial case series. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 110:593-6.
- 11. Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, Ward BB, Kademani D. American Association of Oral and Maxillofacial Surgeons’ Position Paper on Medication-Related Osteonecrosis of the Jaw-2022 Update. J Oral Maxillofac Surg. 2022;80:920-43
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a condition that occurs in the presence of exposed and necrotic bone in the maxillofacial region for more than 8 weeks in patients treated with antiangiogenic or antiresorptive drugs without a history of radiotherapy. This case report aims to present the management of maxillary jaw osteonecrosis caused by tooth extraction in a patient using IV (intravenous) bisphosphonates following surgical removal of the necrotic lesion supported with the use of oral pentoxifylline and alpha tocopherol.
An 80-year-old female patient has been using IV bisphosphonates (zoledronic acid, ibandronic acid, alendronate sodium) regularly for osteoporosis diagnosed in 2011. The patient applied to the Oral and Maxillofacial Surgery Clinic of Akdeniz University Faculty of Dentistry in 2021 due to osteonecrosis in the left maxilla, which developed after extraction of tooth number 23 at a different center. Pentoxifylline and alpha tocopherol treatment was started and continued for 2 months preoperatively. Following the use of the drug, extensive resection including areas of necrosis was performed and improvement together with resolution of symptoms were observed.
Medical treatment with Pentoxifylline and alpha tocopherol is an effective supportive option for the management of
maxillary MRONJ.
Keywords
References
- 1. Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, et al. American Association of Oral and Maxillofacial Surgeons position paper on medicationrelated osteonecrosis of the jaw-2014 update. J Oral Maxillofac Surg. 2014;72:1938. 2. Wood J, Bonjean K, Ruetz S, Ballahcene A, Devy L, Foidart JM. Novel antiangiogenic effects of the bisphosphonate compound zoledronic acid. J Pharmacol Exp Ther. 2002;302:1055-61.
- 3. Santini D, Vincenzi B, Avvisati G, Dicuonzo G, Salerno A, Denaro V. Pamidronate ınduces modifications of circulating angiogenic factors in cancer patients. Clin Cancer Res. 2002; 8:1080-4
- 4. Stepan JJ, Alenfeld F, Boivin G, Feyen JH, Lakatos P. Mechanisms of action of antiresorptive therapies of postmenopausal osteoporosis. Endocr Regul. 2003;37:225-38.
- 5. Mohamed HAM, Nielsen CEN, Schiodt M. Medication related osteonecrosis of the jaws associated with targeted therapy as monotherapy and in combination with antiresorptives. A report of 7 cases from the Copenhagen Cohort. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018;125:157-63.
- 6. Li J, Wang W. Positive effect of pentoxifylline on medication-related osteonecrosis of the jaw. Journal of Stomatology, Oral Maxillofac Surg. 2020;121:264-7.
- 7. Otto S, Abu-Id MH, Fedele S, Warnke PH, Becker ST, Kolk A, et al. Osteoporosis and bisphosphonates-related osteonecrosis of the jaw: not just a sporadic coincidence–a multi-centre study. J Cranio-Maxillofac Surg. 2011;39:272-7.
- 8. Delanian S, Depondt J, Lefaix JL. Major healing of refractory mandible osteoradionecrosis after treatment combining pentoxifylline and tocopherol: a phase II trial. Head Neck 2005;27:114-23.
- 9. Delanian S, Chatel C, Porcher R, Depondt J, Lefaix J. Complete restoration of refractory mandibular osteoradionecrosis by prolonged treatment with a pentoxifylline-tocopherol-clodronate combination (PENTOCLO): A phase II trial. Int J Radiat Oncol Biol Phys. 2011;80:832-9.
- 10. Epstein MS, Wicknick FW, Epstein JB, Berenson JR, Gorsky M. Management of bisphosphonate-associated osteonecrosis: Pentoxifylline and tocopherol in addition to antimicrobial therapy. An initial case series. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 110:593-6.
- 11. Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, Ward BB, Kademani D. American Association of Oral and Maxillofacial Surgeons’ Position Paper on Medication-Related Osteonecrosis of the Jaw-2022 Update. J Oral Maxillofac Surg. 2022;80:920-43
Details
| Primary Language | English |
|---|---|
| Subjects | Oral and Maxillofacial Surgery |
| Journal Section | Case Reports |
| Authors | |
| Publication Date | April 30, 2024 |
| Submission Date | August 14, 2023 |
| Published in Issue | Year 2024 Volume: 3 Issue: 1 |
Başlangıç: 2022
Yayın Aralığı: Yılda 3 sayı
Yayıncı: Akdeniz Üniversitesi