Bisfosfonatima uzrokovana osteonekroza gornje vilice

Aleksandar I Kiralj; Slobodan A Lončarević; Ivana R Mijatov

doi:10.2298/VSP151228199K

Aleksandar I Kiralj Clinical Center of Vojvodina, Clinic for Maxillofacial and Oral Surgery, Novi Sad, Serbia; Univeristy of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Slobodan A Lončarević Military Medical Academy, Clinic for Maxillofacial, Oral Surgery and Implantology, Belgrade, Serbia; University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
Ivana R Mijatov Clinical Center of Vojvodina, Clinic for Maxillofacial and Oral Surgery, Novi Sad, Serbia; Univeristy of Novi Sad, Faculty of Medicine, Novi Sad, Serbia

DOI: https://doi.org/10.2298/VSP151228199K

Ključne reči: bisphosphonate-associated osteonecrosis of the jaws||, ||osteonekroza vilica, uzrokovana bisfosfonatima, diagnosis||, ||dijagnoza, drug therapy||, ||lečenje lekovima, oral surgical procedures||, ||hirurgija, oralna, procedure, treatment outcome||, ||lečenje, ishod,

Sažetak

Uvod. Bisfosfonati spadaju u grupu lekova koja ima značajno mesto u lečenju nekih bolesti kostiju. Bisfosfonatima uzrokovana osteonekroza vilica (BRONJ) je retka komplikacija intravenske bisfosfonatne terapije. Mehanizam kojim bisfosfonati uzrokuju osteonekrozu još uvek nije u potpunosti razjašnjen. BRONJ je definisan od strane Američkog udruženja maksilofacijalnih i oralnih hirurga (AAOMC) i klasifikovan u četiri stadijuma (0-3). Tretman zavisi od stadijuma bolesti i podrazumeva konzervativni tretman (u stadijumima 0 i 1), hirurški debridman (u stadijumu 2) i sekvestrektomiju (u stadijumu 3). Prikaz bolesnika. U radu je prikazana bolesnica kojoj je operisan karcinom dojke, u fazi 3 BRONJ-a gornje vilice nakon terapije zolendroičnom kiselinom zbog difuznih metastaza na kičmenim pršljenovima. Pre početka terapije bisfosfonatima bolesnica je bila podvrgnuta stomatološkom tretmanu. Osteonekroza gornje vilice počela je godinu i po dana nakon početka terapije bisfosfonatima, a nakon ekstrakcije zuba 24. Bolesnica je na početku bila lečena od strane oralnog hirurga prema protokolu AAOMS. Zbog dalje progresije bolesti bolesnica je upućena maksilofacijalnom hirurgu. Nakon sprovedene dijagnostike kompjuterizovanom tomografijom, isplanirana je resekcija gornje vilice. Zaključak. BRONJ je stanje sa specifičnom kliničkom slikom, koje može imati ozbiljne posledice za bolesnike zbog čega se mora istaći značaj screening-a. Lekari različitih specijalnosti (onkolog, stomatolog, oralni i maksilofacijalni hirurg) moraju sarađivati i kontrolisati bolesnike koji su na terapiji bisfosfonatima, kako pre, tako tokom i nakon terapije, u cilju sprečavanja, blagovremenog prepoznavanja i pravilnog lečenja ove komplikacije.

Biografije autora

Aleksandar I Kiralj, Clinical Center of Vojvodina, Clinic for Maxillofacial and Oral Surgery, Novi Sad, Serbia; Univeristy of Novi Sad, Faculty of Medicine, Novi Sad, Serbia

maksilofacijalni hirurg, redovni profesor Medicinskog fakulteta u Novom Sadu (katedra za stomatologiju sa maksilofacijalnom hirurgijom)

Slobodan A Lončarević, Military Medical Academy, Clinic for Maxillofacial, Oral Surgery and Implantology, Belgrade, Serbia; University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia

maksilofacijalni hirurg, docent na medicinskom fakultetu u Kragujevcu

Ivana R Mijatov, Clinical Center of Vojvodina, Clinic for Maxillofacial and Oral Surgery, Novi Sad, Serbia; Univeristy of Novi Sad, Faculty of Medicine, Novi Sad, Serbia

maksilofacijalni hirurg, asistent na Medicinskom fakultetu u Novom Sadu (Katedra za stomatologiju sa maksilofacijalnom hirurgijom)

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