Abstract:

Objective To examine the outcome of surgical treatment in patients with stages Ⅱ-Ⅲ bisphosphonate-related osteonecrosis of the jaw. Methods Twenty-nine patients with bisphosphonate-related osteonecrosis of the jaw were examined. The patients were followed up for more than 6 months, and the treatment outcome was reviewed. Results After curettage of local lesions, 19 out of the 21 patients were cured, and 2 were relieved of symptoms. Six patients underwent subtotal resection of the maxilla, and the symptoms disappeared completely after the surgery. Two patients underwent partial resection of the mandible and recovered. Conclusion Surgical debridement is an effective measure for the treatment of patients with bisphosphonate-related osteonecrosis of the jaw in stages Ⅱ-Ⅲ. In most cases, curettage of local lesions via the intraoral approach can completely remove sequestrum and inflammatory granulomatous tissue. Subtotal maxillary resection or partial mandible resection is performed when the bone death reaches the level of the maxillary sinus floor or continues to the mandible. By timely surgical intervention, the bone lesion is removed to maintain the sterile, active bone microenvironment locally.

Key words: bisphosphonates, osteonecrosis of the jaw, surgical treatment, curettage of local lesions, subtotal resection of maxilla, partial resection of mandible

摘要：

目的 探讨Ⅱ~Ⅲ期双膦酸盐相关颌骨坏死的手术治疗经验。方法 Ⅱ~Ⅲ期双膦酸盐相关颌骨坏死患者29例,随访6个月以上,观察手术效果。结果 21例患者接受局部病灶刮除术后,有19例痊愈,2例缓解;6例患者接受了上颌骨次全切除术,术后症状完全消失;2例患者接受了下颌骨部分切除术,术后痊愈。结论 外科清创是治疗Ⅱ~Ⅲ期双膦酸盐相关颌骨坏死的有效措施,多数通过口内入路行局部病灶刮除术可彻底清除死骨和炎性肉芽组织,当死骨累及上颌窦底水平或下颌骨连续性时,则行上颌骨次全切除术或下颌骨部分切除术,通过及时外科干预去除病变骨质,以保持局部有活力骨微环境的无菌状态。

关键词: 双膦酸盐, 颌骨坏死, 手术治疗, 局部病灶刮除术, 上颌骨次全切除术, 下颌骨部分切除术