- 期刊
Long-term Therapeutic Processing of Various Bonerelated Conditions in Bisphosphonate-related Osteonecrosis of the Jaw: A Case Report
雙磷酸鹽類藥物引發下顎骨骨壞死於不同狀況之治療過程－病例報告
摘要
雙磷酸鹽類藥物依給藥路徑分為口服與針劑，輕度骨質疏鬆的患者常口服福善美，癌症骨轉移的患者常注射卓骨祂。雙磷酸鹽類藥物使骨代謝受抑制，此時如有侵入性治療使顎骨創傷如拔牙，會造成在口腔有傷口癒合不良、骨頭暴露、死骨和管等問題。本病例為四十歲女性因乳癌骨轉移，以靜脈注射卓骨祂控制骨轉移與疼痛，於診所拔牙後造成傷口癒合不良合併骨髓炎及骨壞死。治療期間顎骨壞死狀況反覆不定、感染時好時壞。治療方式依照分期，施予每周數次非手術換藥與四次手術清創，治療將近四年，目前傷口癒合良好，患者持續追蹤觀查。
並列摘要
Bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) occurs when an uncovered area of the jawbone in the oromaxillary region has not healed within 8 weeks. Patients who have not previously undergone radiation therapy in the craniofacial region but received BP therapy. BRONJ is believed to be caused by trauma to dentoalveolar structures, which have a limited capacity for bone healing because of the effects of BP therapy. BRONJ typically manifests as incomplete healing of an extraction socket, exposed bone, sequestrum, and fistula tract formation involving the maxillofacial structures. This article reports the case of a 40-year-old woman with breast cancer involving bone metastasis who had undergone 3 years of therapy with zoledronic acid. She complained of a painful unhealed wound at the left mandible, which formed after having a tooth extracted one year ago. The management strategies for this patient were discontinuing BP therapy, using oral antimicrobial rinses alone and in combination with antibiotic therapy, and debridement which may achieve long-term palliation with resolution of acute infection and pain. The patient underwent 45 months of long-term therapeutic processing, and the healing of the wound sometimes improved, and sometimes worsened. Currently, the wound has healed effectively and the patient has been followed up closely.
延伸閱讀
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