雙磷酸鹽類藥物引發上顎骨骨壞死之治療與重建－病例報告

Treatment and Reconstruction of Bisphosphonate Related Osteonecrosis at Jaw-A Case Report

喻大有(Da-Yo Yuh) ； 張婷菡(Ting-Han Chang) ； 吳契璁(Chi-Tsung Wu) ； 張燕清(Yen-Ching Chang) ； 李曉屏(Shiao-Pieng Lee) ； 夏毅然(Yi-Jan Hsia) ； 石淦生(Kan-Shan Shih) ； 陳元武(Yuan-Wu Chen)

《臺灣口腔顎面外科學會雜誌》 22卷1期 (2011/03) Pp. 20-29

https://doi.org/10.7104/TJOMS.201103.0020

摘要

雙磷酸鹽類藥物是近年來廣爲使用之骨質疏鬆症用藥，可降低骨質疏鬆引起的骨折發生率。長期使用雙磷酸鹽藥物者可能會有拔牙後傷口癒合不良、骨頭暴露、骨頭疼痛、顎骨壞死等副作用，而嚴重上顎骨壞死可能導致口竇相通。本病例因服用雙磷酸鹽類藥物，於拔牙後造成上顎骨骨髓炎及形成骨壞死導致口竇相通。於六個月的治療期間，經兩次清創手術治療，製作閉塞器解決口竇相通問題，以及重建咬合，使患者生活品質獲得改善。

關鍵字

雙磷酸鹽類藥物 ； 口竇相通 ； 口竇閉塞器

並列摘要

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a relatively uncommon but potentially serious complication of treatment with nitrogen-containing bisphosphonates. This is a case of BRONJ in maxilla. After six months treatment, including sustained change dressing and twice surgical debridement, the refractory osteonecrosis was completely recovered. The wound had healed well, but inevitably an oroantral communication was happened. This problem results in difficulty in swallowing, and speech function. The rehabilitation of patients with the acquired defect of the maxilla is a challenge in terms of re-establishing oroantral separation. The goal is achieved by prosthetic rehabilitation with an obturator prosthesis. Not only the oroantral separation but also the acceptable occlusion were obtained. Life quality of the patient has been improved vastly after a series of wound treatment and oral reconstruction.

並列關鍵字

Bisphosphonate-related osteonecrosis of the jaw BRONJ ； Oroantral communication ； Oral obturator