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Case No. 205
2010-03-29~2010-04-11
출제자 : 관리자
Hit : 463
| Period | 2010-03-29~2010-04-11 |
|---|---|
| Diagnosis | |
| Clinical information | 68 year-old woman has been complained a foul odor and pus around the left maxillary 2nd molar tooth area after dental extraction. She had taken a medicine for osteoporosis during 4 years. |
| Discussion | 정답: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) Imaging findings Left maxilla 에 osteonecrosis에 의한 sequestrum이 보이고, left mandible angle 부위도 osteosclerosis가 동반되어 있다. 1. Bisphosphonate -decrease bone turnover by inhibiting osteoclast-mediated bone resorption -treat osteoporosis, Paget disease, malignancy-related hypercalcemia 2. Definition (all of the followings) 1) Current or previous treatment with a bisphosphonate 2) Exposed bone in the maxillofacial region that has persisted for more than eight weeks 3) No history of radiation therapy to the jaws 3. Risk factor -Dental extraction or other dentoalveolar procedure -Potent drug with longer duration with IV use Zometa (zoledronate) > pamidronate > alendronate -DM, chemotherapy, steroid therapy 4. Mandible > maxilla (2:1) -Strong occlusal force, high bone turnover -Bisphosphonate decrease bone turnover -Predispose bone to accumulated microdamage 5.Presence of osteomyelitis -Osteolysis, soft tissue swelling, periosteal new bone formation, periapical lucency, oroantral fistula, sequestrum |
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