Publication: BİFOSFONAT KULLANIMINA BAĞLI ÇENE KEMİKLERİNDE GÖRÜLEN OSTEONEKROZ VAKALARININ MEDİKAL VE CERRAHİ TEDAVİLERİ SONRASI UZUN DÖNEM TAKİPLERİ
Abstract
Amaç: Bu çalışman amacı bifosfonata bağlı çenekemiğinin osteonekrozu (Bisphosphonate RelatedOsteonecrosis of the Jaws [BRONJ]) tanısı konmuşhastaların, yapılan medikal ve cerrahi tedavileri sonrasındatedavilerinin başarısını görmek ve uzun dönemtakibin önemini vurgulamaktır.Gereç ve Yöntem: BRONJ tanısı konulmuş, altısıkadın ikisi erkek olmak üzere 8 hastanın ilaç ve cerrahitedavileri ve uzun dönem klinik ve radyolojik takipsonuçları değerlendirilmiştir. Ruggiero ve arkadaşlarınınoluşturduğu evrelendirmeye göre vakalar evrelendirilmişve tedavileri yapılmıştır. Hastaların üçü osteoporoz(biri intravenöz, ikisi oral yoldan), kalan beşimalignite (intravenöz yoldan) nedeneniyle bifosfonatkullanmaktadır.Bulgular: Hastalar 8 ila 43 ay arasında değişen,ortalama 23.8 aylık süreyle bifosfonat grubu ilaçalmışlardır. Hastaların ortalama yaşları 61.2 ve tedavisonrası ortalama takip süreleri ise 12.5 aydır. , 8vakanın beşi evre 3, diğer üçü ise evre 2 olarak değerlendirilmiştir.Evre 3 hastaların hiçbirinde, medikal vecerrahi tedavi sonrası belirtilen takip süresince klinikve radyolojik olarak BRONJ rekürrensi görülmemiştir.Evre 2 vakalarda ise ilaç tedavisi sonrası hastalıksemptomatik olarak kontrol altına alınmıştır.Sonuç : Sonuç olarak uygulanan bu tedavi protokolüve bu çalışmaya dahil edilen vakalardan elde edilenveriler, cerrahi tedavinin gerektiğinde uygun zamandayapılmasının önemini güçlendirmiştir. Ayrıca hiperbarikoksijen tedavisinin BRONJ vakalarında yardımcı tedaviyöntemlerinden biri olarak düşünülebileceği söylenebilir.Bifosfonat kullanım nedenleri hastaların cerrahi yada medikal yolla tedavi edilmelerinde direkt olaraketkili olmamıştır.
Aim: The aim of this study is to observe the success of medical and surgical treatment of the patients who have been diagnosed as the bisphosphonate related osteonecrosis of the jaws (BRONJ) and emphasize the importance of long term follow up of these patients. Material and Methods: The medical and surgical treatments and long term clinical and radiological follow ups of 8 BRONJ cases, of whom 6 women and 2 men, were evaluated in this study. All cases were staged according to a staging system that was implemented by Ruggiero et al. and treated accordingly. Three of the patients (one intravenously and two orally) were on bisphosphonate due to osteoporosis and five of them (intravenously) due to malignant diseases. Results: Patients were on bisphosphonate for an interval of 8 to 43 months with a mean time period of 23.8 months. The mean age of the patients was 61.2 and the mean postoperative follow up time was 12.5 months. According to Ruggiero et al BRONJ staging, 5 of 8 cases were at stage-3 and the rest of them were at stage-2. None of the stage-3 cases that were treated medically and surgically showed any BRONJ recurrence clinically and radiographically during their follow up periods. Also, all three stage-2 BRONJ cases were kept under control symptomatically with medical treatment protocol. Conclusion: As a conclusion, the treatment protocol and outcome data of this study on BRONJ cases have reinforced the importance of surgical treatment that is performed at an appropriate time. Also it is possible to emphasize that hyperbaric oxygen treatment can be an adjuvant treatment method for BRONJ cases. The reason of bisphosphonate usage of these patients did not directly have any effect on either they treated surgically or medically.
Aim: The aim of this study is to observe the success of medical and surgical treatment of the patients who have been diagnosed as the bisphosphonate related osteonecrosis of the jaws (BRONJ) and emphasize the importance of long term follow up of these patients. Material and Methods: The medical and surgical treatments and long term clinical and radiological follow ups of 8 BRONJ cases, of whom 6 women and 2 men, were evaluated in this study. All cases were staged according to a staging system that was implemented by Ruggiero et al. and treated accordingly. Three of the patients (one intravenously and two orally) were on bisphosphonate due to osteoporosis and five of them (intravenously) due to malignant diseases. Results: Patients were on bisphosphonate for an interval of 8 to 43 months with a mean time period of 23.8 months. The mean age of the patients was 61.2 and the mean postoperative follow up time was 12.5 months. According to Ruggiero et al BRONJ staging, 5 of 8 cases were at stage-3 and the rest of them were at stage-2. None of the stage-3 cases that were treated medically and surgically showed any BRONJ recurrence clinically and radiographically during their follow up periods. Also, all three stage-2 BRONJ cases were kept under control symptomatically with medical treatment protocol. Conclusion: As a conclusion, the treatment protocol and outcome data of this study on BRONJ cases have reinforced the importance of surgical treatment that is performed at an appropriate time. Also it is possible to emphasize that hyperbaric oxygen treatment can be an adjuvant treatment method for BRONJ cases. The reason of bisphosphonate usage of these patients did not directly have any effect on either they treated surgically or medically.