ビスフォスフォネート関連顎骨壊死治療
- Advisory Task Force on Bisphosphonate-Related Ostenonecrosis of the Jaws, American Association of Oral and Maxillofacial Surgeons. J Oral Maxillofac Surg. 2007 Mar;65(3):369-76.
- BRONJ* Staging
- *Exposed, necrotic bone in the maxillofacial region without resolution in 8 to 12 weeks in persons treated with a bisphosphonate who have not received radiation therapy to the jaws.
- †Regardless of the disease stage, mobile segments of bony sequestrum should be removed without exposing uninvolved bone. The extraction of symptomatic teeth within exposed, necrotic bone should be considered because it is unlikely that the extraction will exacerbate the established necrotic process.
- ‡Discontinuation of the IV bisphosphonates shows no short-term benefit. However, if systemic conditions permit, long-term discontinuation may be beneficial in stabilizing established sites of BRONJ, reducing the risk of new site development, and reducing clinical symptoms. The risks and benefits of continuing bisphosphonate therapy should be made only by the treating oncologist in consultation with the OMS and the patient.
- §Discontinuation of oral bisphosphonate therapy in patients with BRONJ has been associated with gradual improvement in clinical disease. Based on the experience of 2 Task Force members managing 50 BRONJ patients who were treated with oral bisphosphonates, discontinuation of oral bisphosphonates for 6 to 12 months may result in either spontaneous sequestration or resolution following debridement surgery. If systemic conditions permit, modification or cessation of oral bisphosphonate therapy should be done in consultation with the treating physician and the patient.
- No treatment indicated
- Patient education
- Antibacterial mouth rinse (such as chlorhexidine 0.12%)
- Clinical follow-up on a quarterly basis
- Patient education and review of indications for continued bisphosphonate therapy
- Symptomatic treatment with broad-spectrum oral antibiotics, eg, penicillin, cephalexin, clindamycin, or firstgeneration fluoroquinolone
- Oral antibacterial mouth rinse
- Pain control
- Only superficial debridements to relieve soft tissue irritation
- Antibacterial mouth rinse
- Antibiotic therapy and pain control
- Surgical debridement/resection for longer term palliation of infection and pain( Regardless of the disease stage, mobile segments of bony sequestrum should be removed without exposing uninvolved bone. The extraction of symptomatic teeth within exposed, necrotic bone should be con sidered because it is unlikely that the extraction will exacerbate the established necrotic process.)
2007年09月27日(木) 17:06:51 Modified by mxe05064