Zusammenfassung
STUDIENZIEL: Osteonekrosen der Kieferknochen werden als intraorale Komplikation unter der Gabe von Stickstoff haltigen Bisphosphonaten beschrieben. In einer retrospektiven Studie wurden Patienten mit Osteonekrosen der Kieferknochen nach Bisphosphonattherapie bezüglich des diagnostischen und therapeutischen Managements nachuntersucht. PATIENTEN UND METHODE: In der Studie wurden 17 Patienten nach Therapie mit Bisphosphonaten inkludiert, die von Juli 2004 bis Juni 2005 an unsere Abteilung überwiesen wurden. Computertomographie, Magnetresonanztomographie, Szintigraphie, Bakteriologie und Biopsie wurden als Untersuchungsmethoden zur Diagnostik der Osteonekrose durchgeführt. Alle Patienten wurden chirurgisch therapiert. RESULTATE: Die Therapie mit Bisphosphonaten wurde aufgrund einer malignen Knochenerkrankung durchgeführt, zwölf Patienten hatten ein multiples Myelom, bei 4 Patienten bestand ein Zustand nach Mammakarzinom und bei einer Patientin war als Grunderkrankung Histiozytosis X diagnostiziert. Fünf Patienten erhielten Pamidronat, 12 Patienten Zoledronat. Im Durchschnitt wurde Pamidronat 36-mal (4–100) in 38 Monaten (4–100) verabreicht und Zoledronat 23,5-mal (5–39) in 26 Monaten (5–39). Bei 9 Patienten war die Läsion im Unterkiefer lokalisiert, bei 8 Patienten im Oberkiefer. Klinische Symptome waren freiliegender Kieferknochen, Kieferschmerzen und eine lokale Entzündung der Mundschleimhaut. Die Computertomographie zeigte sklerotische Kieferanteile in den Zonen der Osteonekrose. Knochenmetastasen konnten mit der Biopsie ausgeschlossen werden. Sequestrektomie und Dekortikation mit anschließender Weichteildeckung zeigte sich als adäquate Therapieform. SCHLUSSFOLGERUNG: Der Einsatz von Stickstoff haltigen Bisphosphonaten erhöht das Risiko Kiefernekrosen zu entwickeln. Um das Risiko einer Kiefernekrose zu reduzieren sollte aus prophylaktischen Gründen eine Kontrolle beim Zahnarzt vor dem Beginn einer intravenösen Therapie mit Bisphosphonaten erfolgen.
Summary
PURPOSE: Osteonecrosis of the jaws is described as an intraoral complication after administration of intravenous nitrogen-containing bisphosphonates. In a retrospective study, patients with osteonecrosis of the jaws after bisphosphonate treatment were evaluated with regard to diagnostic investigations and therapeutic management. PATIENTS AND METHODS: Seventeen patients with osteonecrosis of the jaws after bisphosphonate treatment who were referred to our department between July 2004 and June 2005 were included in this study. Computer tomography, magnetic resonance imaging, scintigraphy, bacteriology and biopsy were used in diagnostic evaluation. All patients were treated surgically. RESULTS: The reasons for bisphosphonate treatment were multiple myeloma in 12 patients, breast cancer with bone metastasis in four patients and histiocytosis X in one patient. Five patients had received intravenous pamidronate and 12 patients zoledronic acid. The median number of treatment cycles for pamidronate was 36 times (range 4–100) in 38 months (range 4–100). Zolendric acid was given 23.5 times (range 5–39) in 26 months (range 5–39). Nine patients had a lesion in the mandible, eight in the maxilla. Clinical symptoms were exposed bone, pain and local inflammation of the mucosa. Computer tomography showed sclerotic areas in the osteonecrosis zone. The biopsy did not show a metastatic lesion. Sequestrectomy and decortication was adequate in the follow-up. CONCLUSION: Nitrogen-containing bisphosphonates appear to be associated with the risk of developing osteonecrosis of the jaws. To reduce this risk, patients should be evaluated by a dentist before beginning treatment with intravenous bisphosphonates.
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Wutzl, A., Eisenmenger, G., Hoffmann, M. et al. Osteonecrosis of the jaws and bisphosphonate treatment in cancer patients. Wien Klin Wochenschr 118, 473–478 (2006). https://doi.org/10.1007/s00508-006-0644-8
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DOI: https://doi.org/10.1007/s00508-006-0644-8