藥物相關顎骨壞死手術處理後之骨再生－病例報告

Bone Regeneration Following Surgical Treatment in Medication-Related Osteonecrosis of Jaw Patients-A Cases Report

吳俊毅(Chun-Yi Wu)；黃則達(Tze-Ta Huang)；陳孟延(Meng-Yen Chen)；蕭凱元(Kai-Yuan Hsiao)；王盛弘(Sheng-Hung Wang)；陳畊仲(Ken-Chang Chen)

藥物相關顎骨壞死 ； 骨再生 ； 手術治療 ； Medication-related osteonecrosis of the jaw (MRONJ) ； Bone regeneration ； Surgical treatment

臺灣口腔顎面外科學會雜誌

35卷3期（2024 / 09 / 01）

209 - 218

繁體中文;英文

藥物相關顎骨壞死病例，因使用抗骨吸收藥物，骨代謝會受到抑制。根據臨床經驗及回顧文獻，發現手術清創後之骨缺損，骨再生極為罕見。本病例報告為藥物相關顎骨壞死患者，手術後發現罕見骨再生情況。病患為一67歲女性患者，因乳癌骨轉移接受capecitabine及denosumab治療，於右下顎產生第三期藥物相關顎骨壞死。放射線影像顯示，右下顎游離腐骨最大徑達5.5公分。Denosumab在手術前已停用三個月，病患於全身麻醉下進行腐骨清除及造碟術，並完全縫合。術後傷口癒合良好，術後則未再使用denosumab。術後定期影像追蹤，經六個月環口放射片發現手術區骨缺損有骨再生現象產生。本文回顧文獻，探討可能促進藥物相關顎骨壞死病例術後骨再生因素。以期待在藥物相關顎骨壞死手術患者中盡可能達成這些條件，促進骨再生，有利於後續的贋復治療，從而提高患者生活品質。

Medication-related osteonecrosis of the jaw (MRONJ) is a condition often associated with using antiresorptive medications, leading to alteration bone metabolism. Consequently, post-surgical bone regeneration in cases of MRONJ is exceedingly rare, as evidenced by clinical experience and literature. This case report presents an uncommon instance of bone regeneration following surgery in a patient with MRONJ. A 67-year-old female patient with breast cancer and bone metastasis was treated with capecitabine and denosumab, resulting in stage III MRONJ in the right side of mandible. Radiographic imaging revealed a sequestrum in the right side of mandible with a maximum diameter of 5.5 cm. Denosumab was discontinued three months before the operation. The patient underwent sequestrectomy, debridement, and complete wound closure under general anesthesia. Postoperative healing was satisfactory, and denosumab was not administered after the surgery. Six months post-surgery, panoramic radiographs indicated bone regeneration in the surgical area. We reviewed the literatures to explore potential factors that may promote postoperative bone regeneration in MRONJ cases. The aim is to fulfill these conditions as much as possible in patients undergoing MRONJ surgery to achieve bone regeneration, which is beneficial for subsequent prosthodontic rehabilitation and thus enhances the patient's quality of life.