Zusammenfassung
Bisphosphonate haben seit vielen Jahren ihren Platz in der adjuvanten Therapie ossär metastasierender Tumoren, des Plasmozytoms und der Osteoporose. Durch pharmakologische Modifikationen konnte deren knochenversiegelnde Eigenschaft gesteigert werden. Wenige Jahre nach Einführung der aktuellen Generation stickstoffhaltiger Bisphosphonate (Pamidronsäure, Zoledronsäure) erschienen erste Berichte über Kieferosteomyelitiden und Kiefernekrosen bei Patienten, die mit diesen Präparaten behandelt wurden und bei denen eine Zahnextraktion stattgefunden hatte. Die vorliegende Arbeit beschreibt aus kieferchirurgischer Sicht erste Erfahrungen mit dieser neuen Form einer medikamentös induzierten Kieferosteomyelitis und gibt Prophylaxeempfehlungen.
Abstract
Bisphosponates have been successfully used in the prevention of cancer related bone metastasis. Ongoing pharmacological modifications have increased their bone sealing potential. A few years after introduction of the latest bisphosphonate generation (pamidronate, zoledronic acid) first reports of jaw osteomyelitis and necrosis after tooth extraction appeared if patients had received bisphosphonates. This study reports on surgical experience with this new kind of therapy-induced jaw osteomyelitis and gives prophylactic recommendations.
Schlüsselwörter
Kiefernekrose - Zahnextraktion - Mammakarzinom - ossäre Metastasen - Bisphosphonate
Key words
Osteonecrosis of the jaw - tooth extraction - breast cancer - bone metastasis - bisphosphonates
Literatur
-
1
Hudson J W.
Osteomyelitis of the jaws: a 50-year perspective.
J Oral Maxillofac Surg.
1993;
51
1294-1301
-
2
Myers R A, Marx R E.
Use of hyperbaric oxygen in postradiation head and neck surgery.
NCI Monogr.
1990;
9
151-157
-
3
Russell R G, Rogers M J.
Bisphosphonates: from the laboratory to the clinic and back again.
Bone.
1999;
25
97-106
-
4
Wood J, Bonjean K, Ruetz S, Bellahcene A, Devy L, Foidart J M, Castronovo V, Green J R.
Novel antiogenetic effects of the bisphonate compound zoeledronic acid.
J Pharmacol Exp Ther.
2002;
302
1055-1061
-
5
Santini D, Vincenzi B, Dicuonzo G. et al .
Zoledronic acid induces significant and longlasting modifications of circulating angiogenetic factors in cancer patients.
Clin Cancer Res.
2003;
9
2893-2897
-
6
Marx R E.
Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic.
J Oral Maxillofac Surg.
2003;
61
1115-1117
-
7
Ruggiero S L, Mehrotra B, Rosenberg T J, Engroff S L.
Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases.
J Oral Maxillofac Surg.
2004;
62
527-534
-
8
Carter G D, Goss A N.
Bisphosphonates and avascular necrosis of the jaws.
Aust Dent J.
2003;
48
268
-
9
Marx R E, Sawatari Y, Fortin M, Broumand V.
Bisphosphonate-induced exposed bone (Osteonecrosis/Osteopetrosis) of the jaws: Risk factors, recognition, prevention and treatment.
J Oral Maxillofac Surg.
2005;
63
1567-1575
-
10
Bamias A, Kastritis E, Bamia C, Moulopoulos L A, Melakopoulos I, Bozas G, Koutsoukou V, Gika D, Anagnostopoulos A, Papadimitriou C, Terpos E, Dimopoulos M A.
Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: Incidence and risk factors.
Journal of Clinical Oncology.
2005;
23
8580-8587
-
11
Zarychansky R, Elphee E, Walton P, Johnston J.
Osteonecrosis of the jaw associated with pamidronate therapy.
American Journal of Hematology.
2006;
81
73-75
-
12
Schwartz H C.
Osteonecrosis and bisphonates: correlation versus causation.
J Oral Maxillofac Surg.
2004;
62
763-764
Dr. Dr. Frank Gerhards
Klinik für Zahn-, Mund-, Kiefer- und Plastische Gesichtschirurgie
Universitätsklinikum Aachen
Pauwelsstraße 30
52074 Aachen
Email: Frank.Gerhards2@post.rwth-aachen.de
